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Peer-reviewedCC BY-NC-NDJACC Advances

Associations of Central Adiposity With Subclinical Coronary Calcification and Disease Progression

  • Shaun Khanna1
  • G. V. Mann2
  • Sohaib A. Virk3
  • Aditya Bhat2
  • Sheran A. Vasanthakumar4
  • Sarang Paleri4
  • Andrew Lin4
  • Lauren Houston5
  • Damini Dey6
  • Deepak L. Bhatt7
  • Clare Gabrielle Arnott8
  • Nitesh Nerlekar9
9 affiliations
  1. 1The George Institute for Global Health, UNSW Sydney, New South Wales, Australia; Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  2. 2Department of Cardiology, Westmead and Blacktown Hospital, Sydney, New South Wales, Australia
  3. 3University of Melbourne, Parkville, Victoria, Australia
  4. 4Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Victorian Heart Institute, Victorian Heart Hospital, Clayton, Victoria, Australia
  5. 5The George Institute for Global Health, UNSW Sydney, New South Wales, Australia
  6. 6Cedars-Sinai Medical Center, Los Angeles, California, USA
  7. 7Department of Cardiology, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  8. 8The George Institute for Global Health, UNSW Sydney, New South Wales, Australia; Department of Cardiology, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
  9. 9Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; Victorian Heart Institute, Victorian Heart Hospital, Clayton, Victoria, Australia. Electronic address: [email protected]
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Abstract

Background 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. Objectives 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. Methods 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 (I ), and between-group differences with chi-square interaction testing. Results 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; I = 81%) and WC (SMD: 0.32; 95% CI: 0.23-0.40; I = 86%) were higher in those with CAC >0, whereas BMI was not significant (SMD: 0.13; 95% CI: –0.03-0.29; I = 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; I = 64%) was more strongly associated than BMI (SMD: 0.21; 95% CI: 0.16-0.27; I = 29%) ( P = 0.01). Conclusions 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 )

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Cite

BibTeXRIS
BibTeX
@article{khanna2026associations,
  title = {{Associations of Central Adiposity With Subclinical Coronary Calcification and Disease Progression}},
  author = {Shaun Khanna and G. V. Mann and Sohaib A. Virk and Aditya Bhat and Sheran A. Vasanthakumar and Sarang Paleri and Andrew Lin and Lauren Houston and Damini Dey and Deepak L. Bhatt and Clare Gabrielle Arnott and Nitesh Nerlekar},
  journal = {JACC Advances},
  year = {2026},
  month = may,
  doi = {10.1016/j.jacadv.2026.102844},
  url = {https://doi.org/10.1016/j.jacadv.2026.102844},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Associations of Central Adiposity With Subclinical Coronary Calcification and Disease Progression
AU  - Shaun Khanna
AU  - G. V. Mann
AU  - Sohaib A. Virk
AU  - Aditya Bhat
AU  - Sheran A. Vasanthakumar
AU  - Sarang Paleri
AU  - Andrew Lin
AU  - Lauren Houston
AU  - Damini Dey
AU  - Deepak L. Bhatt
AU  - Clare Gabrielle Arnott
AU  - Nitesh Nerlekar
PY  - 2026
DA  - 2026/05/21
JO  - JACC Advances
DO  - 10.1016/j.jacadv.2026.102844
UR  - https://doi.org/10.1016/j.jacadv.2026.102844
AB  - Background 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. Objectives 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. Methods 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 (I ), and between-group differences with chi-square interaction testing. Results 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; I = 81%) and WC (SMD: 0.32; 95% CI: 0.23-0.40; I = 86%) were higher in those with CAC >0, whereas BMI was not significant (SMD: 0.13; 95% CI: –0.03-0.29; I = 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; I = 64%) was more strongly associated than BMI (SMD: 0.21; 95% CI: 0.16-0.27; I = 29%) ( P = 0.01). Conclusions 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 )
SN  - 2772-963X
ER  -