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Waist circumference may provide a more accurate gauge of cardiovascular risk than body mass index, according to findings from a major study published in the Journal of the American College of Cardiology. Researchers analyzed nearly 260,000 adults participating in 15 separate long-term health studies, tracking their health outcomes over approximately two decades.
The Cross-Cohort Collaboration discovered that individuals within normal or overweight BMI ranges who had larger waist measurements or elevated waist-to-hip ratios faced significantly elevated risks of heart attack, stroke, heart failure, atrial fibrillation and cardiovascular death. These high-risk individuals showed a 15% to 50% greater likelihood of experiencing serious cardiac events compared to peers with smaller waist circumferences.
The distinction matters because BMI measures only the relationship between weight and height, overlooking how fat distributes throughout the body. Registered dietitian Erin Palinski-Wade explained that visceral fat—the metabolically active tissue surrounding abdominal organs—drives inflammation and artery damage at a greater rate than fat stored elsewhere, making location a critical factor in assessing heart health.
Researchers acknowledged several study limitations, including the absence of data on physical activity, dietary habits and genetic predisposition to obesity among participants. Additionally, waist measurements were taken only once per person, preventing scientists from analyzing how changes in abdominal fat over time influence cardiovascular disease development.
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