Study finds abdominal fat predicts heart disease risk better than BMI
A large-scale analysis published in the Journal of the American College of Cardiology reveals that waist circumference and waist-to-hip ratio are superior indicators of cardiovascular disease risk compared to body mass index alone.
A comprehensive study published in the Journal of the American College of Cardiology indicates that waist circumference and waist-to-hip ratio are superior predictors of cardiovascular disease risk compared to body mass index alone. Led by the Cross Cohort Collaboration, the research analysed data from over 260,000 individuals over an average follow-up period of 20 years. The findings suggest that relying solely on traditional BMI metrics can lead to significant misclassification of cardiovascular risk in primary prevention settings.
Researchers found that individuals with a normal or overweight BMI but high central adiposity faced a 15% to 50% greater risk for most cardiovascular outcomes. These outcomes included fatal and non-fatal myocardial infarction, stroke, heart failure, atrial fibrillation, and mortality. The study examined nine specific outcomes, highlighting that where fat is distributed matters more than total body weight alone.
The analysis identified significant misclassification rates within standard BMI categories. Among individuals with a normal BMI, 5% had high waist circumference and 18% had high waist-to-hip ratio. Conversely, among those classified as overweight, 39% had high waist circumference and 40% had high waist-to-hip ratio. In contrast, 9% of individuals with obesity had low waist circumference and 45% had low waist-to-hip ratio.
Michael J. Blaha, senior author and director of clinical research at Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, noted that waist circumference and waist-to-hip ratio reclassify risk defined by traditional BMI thresholds. The study found that individuals with clinically determined normal weight but elevated central adiposity were associated with higher risk across most outcomes, challenging the utility of BMI as a standalone diagnostic tool.
Experts, including the Editor-in-Chief of the Journal of the American College of Cardiology, are urging clinicians to incorporate central adiposity measures into routine risk assessments. Harlan M. Krumholz of the Yale School of Medicine stated that it is time to abandon a sole focus on body mass index, emphasising that these simple measures should be part of routine cardiovascular risk assessment to avoid overlooking high-risk patients with normal weight.
