Researchers identified a 94-metabolite signature associated with body mass index that strongly predicts coronary heart disease risk. In 1,200 participants from the Southern Community Cohort Study, each standard deviation increase in this metabolite profile raised heart disease risk by 48%. Among 95 bariatric surgery patients, the signature also predicted 30-year cardiovascular risk, with specific metabolites like choline and acetyl-2-aminoadipate changing significantly 3 and 12 months post-surgery. This metabolic fingerprint represents a potentially powerful advance in personalized cardiovascular risk assessment. Unlike traditional single biomarkers, this comprehensive profile captures the complex metabolic dysregulation underlying obesity-related heart disease. The signature's responsiveness to bariatric surgery suggests it could monitor treatment effectiveness and guide clinical decisions. However, this preprint awaits peer review, and findings may change. The study's strength lies in combining population-level prediction with surgical intervention data, though the surgical cohort was relatively small. If validated, this blood-based panel could transform how clinicians stratify cardiovascular risk and personalize prevention strategies for obesity-related heart disease.