Associations of Central Adiposity With Subclinical Coronary Calcification and Disease Progression: Meta-Analysis of...

Coronary artery calcium (CAC) is a robust marker of subclinical atherosclerosis and cardiovascular risk. Body mass index (BMI) may inadequately reflect central adiposity, which may be more strongly associated with CAC burden and progression.

The objective of the study was to compare associations of BMI, waist circumference (WC), and waist-to-hip ratio (WHR) with CAC presence and progression in individuals without established cardiovascular disease.

A systematic search of PubMed, MEDLINE, Embase, CINAHL, Scopus, and gray literature (January 2000-March 2025) identified studies reporting anthropometric measures by CAC status (CAC = 0 vs >0) or progression. Two reviewers applied Preferred Reporting Items for Systematic reviews and Meta-Analyses-based criteria. Standardized mean differences (SMDs) were pooled using random-effects models. Heterogeneity was assessed with I-squared statistic (I²), and between-group differences with chi-square interaction testing.

Forty-nine studies were included (33 CAC presence; 16 progression) across 10 countries. For CAC presence (n = 43,490), WHR (SMD: 0.46; 95% CI: 0.35-0.56; I² = 81%) and WC (SMD: 0.32; 95% CI: 0.23-0.40; I² = 86%) were higher in those with CAC >0, whereas BMI was not significant (SMD: 0.13; 95% CI: -0.03-0.29; I² = 98%). WHR showed a stronger association than WC (P = 0.04). Meta-regression indicated attenuation with higher hypertension prevalence. For CAC progression (n = 25,141; mean follow-up 4.9 ± 3.0 years), WC (SMD: 0.34; 95% CI: 0.27-0.42; I² = 64%) was more strongly associated than BMI (SMD: 0.21; 95% CI: 0.16-0.27; I² = 29%) (P = 0.01).

Central adiposity measures (WHR and WC) show stronger associations with CAC presence and progression than BMI, supporting their use as markers of cardiovascular risk while highlighting limitations of BMI alone. (Anthropometrics and subclinical coronary artery calcification: a systematic review and meta-analysis; CRD420251083057).