Reti-CVD is a deep learning-based algorithm that estimates cardiovascular disease (CVD) risk through analysis of retinal fundus images. As a non-invasive and accessible tool that does not require blood tests or radiation exposure, it has gained interest as a novel screening method.This study aimed to investigate the relationship between Reti-CVD scores and coronary artery calcium scores (CACS), and to evaluate predictive differences according to body mass index (BMI) using subgroup analysis in a health screening population.A retrospective cross-sectional study was conducted on 147 adults who underwent both retinal imaging and coronary CT at a university hospital in XXX Province, XXX, in 2024. Reti-CVD scores were calculated using a deep learning model based on retinal images. CACS was binarized: a score of 0 was defined as the non-calcified group, and ≥1 as the calcified group. Covariates included hypertension, DM, dyslipidemia, waist circumference, BMI, SBP, DBP, HbA1c, liver enzymes, renal markers and lipid profiles.The presence of coronary artery calcium was significantly associated with higher Reti-CVDscores (β = 3.84, p = 0.014). Hypertension (β = 3.69, p = 0.029) and systolic blood pressure (β = 0.21, p = 0.006) were also significant predictors. In subgroup analysis, participants with BMI ≥ 25.0 (n = 66) showed a stronger association between CACS and Reti-CVD (β = 6.03, p = 0.012). In contrast, the BMI < 25.0 group (n = 81) showed no significant association between CACS and Reti-CVD (p = 0.131), while SBP, DBP, and BMI remained significant predictors.The Reti-CVD score demonstrated a significant association with coronary artery calcium, particularly in overweight and obese individuals, suggesting that it reflects structural vascular changes. The observed associations with hypertension and blood pressure support the hypothesis that retinal microvascular changes correlate with systemic vascular health.Reti-CVD was more sensitive to coronary calcification in individuals with higher BMI, indicating that this algorithm maybe especially useful in identifying high-risk groups. These findings support the potential of Reti-CVD as an adjunctive tool for early risk stratification and clinical decision-making. Reti-CVD may serve as a scalable biomarker for cardiovascular screening in both primary care and health screening settings.