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Cardiac computed tomography at the year 25 exam was used to assess the presence of CAC (CAC &amp;gt; 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\u20133.49) 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\u20131.016).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf236","type":"journal-article","created":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T11:32:42Z","timestamp":1754998362000},"page":"1728-1735","source":"Crossref","is-referenced-by-count":0,"title":["Long-term adiposity in early adulthood affects coronary artery calcification incidence in midlife: a 25-year longitudinal study"],"prefix":"10.1093","volume":"26","author":[{"given":"Shunyi","family":"Li","sequence":"first","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 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Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiming","family":"Zhao","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Song","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shichao","family":"Li","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sijie","family":"Jiang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 ,","place":["China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weijing","family":"Feng","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University , Guangzhou 510515 ,","place":["China"]},{"name":"Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Southern Medical University , Guangzhou 510515 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