Long-term adiposity in early adulthood affects coronary artery calcification incidence in midlife: a 25-year longitudinal study

AIMS: The study aimed to evaluate longitudinal adiposity exposure, assessed by body roundness index (BRI), from young adulthood and its association with the risk of coronary artery calcification (CAC) incidence in mid-life. METHODS AND RESULTS: We included 2102 participants from the CARDIA study with available BRI measurements at eight follow-up visits over 25 years. Cardiac computed tomography at the year 25 exam was used to assess the presence of CAC (CAC > 0). The cumulative BRI (cBRI) was calculated as the mean of the BRI between consecutive visits multiplied by the number of years. Logistic regression models and restricted cubic spline (RCS) analyses were used to assess the relationship between cBRI and the risk of CAC incidence. A total of 598 participants developed CAC over the 25-year follow-up period. Higher cBRI was associated with an increased risk of CAC incidence. Participants were divided into four quartiles based on cBRI. In model 3, the odds ratio (OR) for CAC was 2.52(95%CI, 1.82-3.49) in the top quartile of cBRI. RCS analyses suggested a linear relationship between cBRI and the risk of CAC incidence. Furthermore, multivariable Cox regression showed that individuals in the higher cBRI had a higher risk of all-cause mortality (1.009; 95% CI, 1.003-1.016). CONCLUSION: Greater cBRI from early adulthood was associated with an elevated risk of CAC incidence in mid-life. These findings uncover potential evidence to support that BRI may be a useful marker for identifying individuals at high risk of CAC.