Study: Waist circumference is the strongest indicator of heart disease risk

Weight gain and obesity, which are risk factors for heart disease, are typically diagnosed based on body mass index (BMI), a ratio of weight to height.

However, BMI does not account for the distribution of body fat. Researchers writing in the American College of Cardiology journal noted that failing to consider waist circumference or the waist-to-hip ratio can lead to misclassification of cardiovascular disease risk.

Dr. Michael Blaha, leader of the research team from Johns Hopkins University, said in a statement that individuals with a normal weight who have excess fat in the midsection and a high waist-to-hip ratio—meaning their waist is large relative to their hips—are at higher risk for most outcomes.

His team analyzed data collected over 20 years from more than 260,000 people.

Among individuals with normal or overweight status, those with a large waist circumference and a high waist-to-hip ratio were 15 to 50 percent more likely to suffer from fatal and non-fatal strokes and heart disease.

In contrast, those with obesity but a low waist circumference had outcomes generally similar to those with a normal weight and a low waist circumference.

Dr. Harlan Krumholz, editor-in-chief of the journal who was not involved in the study, said, “It is time to move away from an exclusive focus on BMI.”

Krumholz added in a statement, “This important study, based on data from hundreds of thousands of participants in large-scale cohort studies, conclusively demonstrates that waist circumference and the waist-to-hip ratio provide critical information regarding cardiovascular disease risk.”