Joint association of the triglyceride–glucose index and central obesity with clinically significant coronary artery calcification in asymptomatic adults

Introduction Clinically significant coronary artery calcium (CAC ≥100) is associated with increased cardiovascular risk. The triglyceride-glucose (TyG) index and central obesity are established markers of metabolic dysfunction and visceral adiposity, respectively. However, whether their combined assessment identifies asymptomatic individuals with clinically significant CAC remains unclear. We investigated the independent and joint associations of the TyG and central obesity with CAC ≥100 in asymptomatic adults.Materials and Methods This cross-sectional study included 2,729 asymptomatic adults who underwent comprehensive health examinations, including computed tomography for CAC assessment, at Taichung Veterans General Hospital between January 2015 and August 2025. Participants were categorized by TyG quartiles and four phenotypes defined by elevated TyG and central obesity. Multivariable logistic regression evaluated associations with CAC ≥100 after adjustment for cardiovascular risk factors.Results Compared with the lowest TyG quartile, the highest quartile had a significantly higher likelihood of clinically significant CAC (adjusted OR 1.54, 95% CI 1.11–2.13; p = 0.009). Compared with the low-TyG with normal-waist group, participants with isolated central obesity and those with isolated high TyG had higher adjusted odds of CAC ≥100. Participants with both elevated TyG and central obesity had the highest likelihood of CAC ≥100 (adjusted OR 1.79, 95% CI 1.30–2.46; p < 0.001).Conclusions A higher TyG index was associated with clinically significant coronary artery calcification. The coexistence of metabolic dysfunction and central obesity identified asymptomatic adults with the highest likelihood of clinically significant CAC, suggesting that joint assessment of the TyG index and central obesity may provide additional information regarding subclinical coronary atherosclerosis.Individuals with both an elevated triglyceride-glucose (TyG) index and central obesity had the highest likelihood of clinically significant coronary artery calcification (CAC ≥100).The combined high-TyG with central-obesity phenotype was associated with CAC ≥100 in both men and women and with higher odds across CAC severity categories.Joint assessment of the TyG index and central obesity may provide complementary information on subclinical coronary atherosclerosis in asymptomatic adults.