Abdominal fat predicts heart disease risk better than BMI

A new study published in JACC, the leading journal of the American College of Cardiology, reveals that abdominal fat measurements, such as waist circumference and waist-to-hip ratio, are more effective at predicting heart disease risk than traditional body mass index (BMI). BMI has long been used to determine obesity, a common risk factor for heart disease, but this research indicates that disregarding waist measurements can lead to incorrect assessments of cardiovascular disease risk.

Michael J. Blaha, MD, MPH, the senior author and director of clinical research at Johns Hopkins Ciccarone Center, explained that "WC and WHR reclassify risk defined by traditional BMI thresholds." The study analyzed data from over 260,000 individuals over a period of 20 years, considering nine cardiovascular outcomes including heart attack, stroke, heart failure, and mortality.

Notably, individuals with normal BMI but high waist measurements exhibited a 15% to 50% increased risk for most outcomes. The researchers emphasize that central adiposity, particularly visceral fat surrounding internal organs, is strongly linked to chronic diseases like heart disease and diabetes. However, BMI does not account for fat distribution and remains the most common metric for diagnosing obesity and assessing cardiovascular risk.

The study's lead author, Zeina A. Dardari, PhD, MS, stresses the importance of considering central adiposity in all BMI categories when evaluating cardiovascular risk during primary prevention. The study's limitations include the absence of data on physical activity, diet, and genetic obesity risk, as well as only one assessment of waist and hip measurements.

Experts agree that it is time to move beyond solely focusing on BMI and incorporate waist circumference and waist-to-hip ratio into routine cardiovascular risk assessments.