Association Between Cardiometabolic Index and Coronary Artery Calcification in Young and Middle-Aged Adults With Coronary Heart Disease

Background: Coronary artery calcification (CAC) serves as a well-established indicator of subclinical atherosclerosis and is a robust predictor of future cardiovascular complications. The cardiometabolic index (CMI), a recently proposed composite metric combining waist-to-height ratio (WHtR) and the triglyceride-to-HDL cholesterol (TG/HDL-C) ratio, has gained attention as a proxy for both visceral fat accumulation and atherogenic dyslipidemia. Nevertheless, the relationship between CMI and CAC in young and middle-aged individuals diagnosed with coronary heart disease (CHD) remains insufficiently explored. Methods: This retrospective analysis included CHD patients aged 18–59 years who were admitted to the hospital and underwent coronary computed tomography angiography (CTA) between January 2018 and August 2022. Based on CTA findings, participants were stratified into CAC-positive and CAC-negative groups. Data on demographics, clinical characteristics, and biochemical parameters were obtained. CMI was computed using the formula WHtR × (TG/HDL-C). Multivariate logistic regression models and receiver operating characteristic (ROC) curve analysis were employed to assess both the association and diagnostic value of CMI for CAC. Results: A total of 439 patients were analyzed, of whom 128 were classified as having CAC. The CAC group exhibited a significantly elevated CMI compared to their counterparts without CAC (P < 0.001). After adjusting for potential confounders, CMI emerged as an independent predictor of CAC (OR = 2.436, 95% CI: 1.694–3.502, P < 0.001), whereas BMI did not reach statistical significance. ROC curve analysis revealed that CMI had superior predictive accuracy relative to BMI (AUC: 0.753 vs. 0.606). The optimal CMI threshold for predicting CAC was 0.742, yielding a sensitivity of 72.81% and a specificity of 70.95%. Conclusion: CMI shows a significant independent association with CAC and outperforms BMI in predicting its presence among young and middle-aged adults with CHD. Given its simplicity, non-invasiveness, and low cost, CMI may represent a practical screening tool for early detection of asymptomatic coronary atherosclerosis in clinical settings.