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We sought to establish whether elevated BMI and body surface area (BSA), two measures of obesity, are predictors of coronary artery calcium (CAC).We retrospectively analyzed 3172 consecutive patients who underwent calcium scoring at our center. We applied a multiple logistic regression model to estimate the independent association between BMI of at least 25 kg/m2 and incidence of CAC with adjustment for covariates. We carried out the same analysis to find out if there is an independent association between BSA of at least 1.71 m2 (commonly used definition for abnormally elevated BSA) and incidence of CAC. We also performed a sex subanalysis based on BMI and BSA.There were 2105 patients in the cohort with BMI of at least 25 kg/m2 compared with 1067 patients with BMI of less than 25 kg/m2. After adjustment for covariates, a significant association was not found between increased BMI and incidence of CAC. In addition, no significant findings were found in the sex subanalysis. A total of 2760 patients had a BSA of at least 1.71 m2 compared with 412 patients with BSA of less than 1.71 m2. After adjustment for covariates, a significant association (odds ratio 2.08, 95% confidence interval 1.16–3.73, P=0.014) was found between elevated BSA and CAC incidence. There were 89 men with BSA of at least 1.9 m2 and 2248 with BSA of at least 1.9 m2. After adjustment for covariates, the logistic regression model showed a significant association (odds ratio 2.24, 95% confidence interval 1.19–4.21, P=0.012) between BSA of at least 1.9 m2 and incidence of CAC.Elevated BSA is a predictor of CAC incidence, whereas elevated BMI is not. Moreover, elevated BSA is a predictor of CAC incidence particularly in men.