Association between coronary artery calcification and cardiometabolic, hepatic, and renal markers in a Chinese population undergoing health examinations.

Objectives

To investigate the prevalence of coronary artery calcification (CAC) in a Chinese population undergoinghealth examinations and to evaluate the associations of cardiometabolic, hepatic, and renal markers with CAC positivity and CAC burden.

Methods

This single-center cross-sectional study included 2,957 Chinese adults who underwent routine health examinations and coronary artery calcium score (CACS) assessment at the Health Management Center of Shanghai Electric Power Hospital between January 1 and December 31, 2025. CAC positivity was defined as CACS > 0. Univariable and multivariable logistic regression analyses were used to identify factors associated with CAC positivity. CAC burden was further evaluated using ordinal logistic regression, linear regression for ln(CACS+1), and logistic regression for CACS ≥ 100.

Results

Among the 2,957 participants, 737 (24.9%) were CAC-positive. In multivariable analyses, older age (adjusted OR=1.133, 95% CI: 1.113-1.153, P < 0.001), male sex (adjusted OR=7.990, 95% CI: 4.381-14.573, P < 0.001), higher body mass index (BMI) (adjusted OR=1.077, 95% CI: 1.036-1.119, P < 0.001), and higher HbA1c levels (adjusted OR=1.338, 95% CI: 1.202-1.491, P < 0.001) were independently associated with CAC positivity. These associations were consistent in sensitivity analyses and across CAC burden models.

Conclusion

CAC is not unusual in the Chinese population undergoing health examinations. Old age, male sex, higher BMI, and higher HbA1c levels were consistently associated with both CAC positivity and higher CAC burden. Age, adiposity, and continuing glycemic exposure are among the routine clinical indicators that may help identify asymptomatic individuals at a high risk of CAC and support additional risk stratification.