Waist measurements may reveal heart disease risk that body mass index (BMI) often misses, according to a new study published in the Journal of the American College of Cardiology (JACC).
Study design shows stark differences in risk
Researchers examined data from 15 prospective cohorts, collectively known as the Cross‑Cohort Collaboration. The analysis covered 259,351 participants with waist circumference (WC) data and 218,984 with waist‑to‑hip ratio (WHR) measurements, tracking outcomes over a median of 20 years.
Among individuals classified as normal weight by BMI, five percent displayed a high WC and 18 percent a high WHR. In the overweight group, roughly 40 percent carried raised central adiposity. The study linked those hidden deposits to a 15‑to‑50 percent increase in risk for heart attack, stroke, heart failure, and atrial fibrillation.
Obesity classifications can be misleading
Conversely, the data suggest BMI may overstate risk for some people with obesity. Nine percent of obese participants had a low WC, and 45 percent showed a low WHR. Those with obesity but low WC generally did not face significantly higher cardiovascular risk than normal‑weight peers with low WC. The WHR findings proved more subtle, especially among women.
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Population‑level estimates highlighted the impact of abdominal fat. Raised WC among obese individuals accounted for about 49 percent of heart failure events, 46 percent of atrial fibrillation cases, and 36 percent of coronary heart disease deaths.
These results reinforce calls for clinicians to look beyond BMI when evaluating obesity and heart health. “Relying on BMI alone, without accounting for measures of central adiposity, can obscure meaningful heterogeneity in CVD risk,” the authors wrote.
Implications for primary prevention
The authors concluded that identifying raised central adiposity is critical, even for people whose BMI falls within the normal or overweight range. “We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings,” they said.
In practice, a simple tape measure might catch risk that a scale alone would miss, offering a more subtle view of heart disease probability. The data also remind patients that weight loss strategies focused on reducing abdominal fat could have outsized benefits for heart health.
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