Risk of Coronary Artery Calcification Based on Degree of Obesity and Age Group in Korean Adults: Analysis of Kangbuk Samsung Health Study Data

Abstract

This study examined the relationship between body mass index (BMI) and coronary artery calcification (CAC) in a large cohort of adults undergoing routine health evaluations, focusing particularly on the modifying role of age. We analyzed health data from 182,008 male employees and their family members in South Korea between 2010 and 2019, categorizing participants by BMI and age. CAC, a validated marker of subclinical atherosclerosis and a predictor of cardiovascular events, was measured via multidetector computed tomography. In unadjusted analyses, overweight and obese individuals exhibited a significantly higher risk of CAC compared to those with underweight BMI. After adjusting for potential confounding factors, obesity remained independently associated with an increased risk of CAC, while the association with overweight was no longer significant. Age strongly influenced this relationship; individuals aged 70 years or older demonstrated a markedly higher CAC risk, but obesity's association with CAC was significant only in those aged 60 years or younger. These findings indicate that obesity, even in the absence of metabolic abnormalities, contributes to an increased risk of atherosclerosis in younger individuals, challenging the concept of "metabolically healthy obesity." In conclusion, our results underscore the importance of targeted cardiovascular risk assessments that consider both BMI and age, highlighting the need for early intervention in younger adults with elevated BMI to prevent atherosclerosis and suggesting a distinct risk profile in older adults.