Waist Circumference Independently Predicts Cardiovascular Risk Beyond BMI
A pooled analysis of multiple cohort studies found that waist size is a significant predictor of cardiovascular risk even in people with normal or overweight BMI. Many individuals with normal weight but large waistlines had elevated risk. The findings suggest that waist measurement should be considered alongside BMI.
The analysis pooled data from 15 cohorts encompassing over a quarter-million participants, tracking them for two decades across various cardiovascular events, including heart attacks, strokes, heart failure, and atrial fibrillation. Standard clinical thresholds for waist circumference and waist-to-hip ratio were applied to categorize central adiposity.
Notably, the study found that a substantial proportion of individuals classified as normal weight still exhibited elevated central adiposity, with 5% having a large waist and 18% a high waist-to-hip ratio. Conversely, among those with obesity, a small waist was relatively uncommon but associated with outcomes similar to normal-weight peers, highlighting the limitations of BMI alone.
This research could reshape primary care practices by encouraging routine waist measurements alongside BMI, potentially reclassifying millions of normal-weight patients as higher cardiovascular risk and prompting earlier preventive treatments. Conversely, it may reassure some individuals with obesity and smaller waists, though integrating new metrics into standard clinical workflows could require significant updates to screening guidelines and physician training.