AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
BMI and Premature Advanced Atherosclerosis in Young to Early Middle-Aged Adults: Cross-Sectional Associations and Prognostic Implications for Cause-Specific Mortality in the Coronary Artery Calcium Consortium
By Dardari Y, Blaha MJ, Choi S et al.
Background: Cardiovascular disease (CVD) and cancer are the leading causes of mortality worldwide. Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and a strong predictor of future cardiovascular events and mortality. Higher body mass index (BMI) has been associated with greater CAC burden, however, the relationship between BMI and premature advanced CAC, as well as its implications for cause-specific mortality in young to early middle-aged adults, remains incompletely characterized. Methods: We analyzed 20,076 young adults (men aged 30-50 years and women aged 35-65 years) with a BMI ≥18.5 kg/m ² from the Coronary Artery Calcium Consortium. We cross-sectionally assessed the prevalence and multivariable adjusted odds of having premature advanced CAC, defined by a CAC score ≥90 th percentile for age, race, and sex, across the following BMI categories: normal weight (BMI 18.5 to <25.0 kg/m ² ), overweight (BMI 25.0 to <30.0 kg/m ² ), and obesity (BMI 30.0 kg/m ² ). Baseline CAC scores were then categorized as CAC =0, CAC <90 th percentile, and CAC ≥90 th percentile. We assessed the adjusted incidence rates (per 1,000 person-years) and mortality risk across CAC and BMI categories, using normal weight with CAC=0 as the reference. Cox proportional hazards and competing-risk regression models were adjusted for age, sex, current smoking status, and family history of CHD to evaluate associations with all-cause, CVD, and cancer mortality. Results: Among our sample, 16% had normal weight, 58% had overweight, and 26% had obesity. The prevalence of premature advanced CAC increased with higher BMI categories (12% vs 13% vs 17%) (Figure 1). Compared with normal-weight individuals, participants with overweight and obesity had higher adjusted odds of premature advanced CAC (OR 1.11, 95% CI 1.01-1.23 and OR 1.45, 95% CI 1.31-1.61, respectively) (Figure 1). During a median follow-up of 21.5 (25 th 19.6, 75 th 23.0) years, compared to the CAC=0 group, individuals with premature advanced CAC had a higher incidence of all-cause, CVD, and cancer mortality across each BMI category (Figure 2). Furthermore, premature advanced CAC was associated with a significantly increased risk of all-cause and CVD mortality in each BMI category, relative to individuals with normal weight and CAC =0 (Figure 3). Premature advanced CAC was associated with increased cancer mortality only among individuals with normal weight (HR 1.52, 95% CI 1.07-2.15) and obesity (HR 1.46, 95% CI 1.01-2.12). Conclusions: Higher BMI is associated with an increased likelihood of premature advanced CAC, the presence of which identifies young adults at substantially elevated long-term risks of all-cause and cardiovascular mortality. These findings suggest that assessment of premature advanced CAC may enhance cardiovascular risk stratification and provide insight into the competing risks of cardiovascular and cancer mortality.