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Compared With Body Mass Index, Abdominal Fat Better Predicts Cardiovascular Risk
Central adiposity is a stronger predictor of adverse cardiovascular outcomes than BMI alone, underscoring the importance of considering the entire BMI spectrum during screening.Compared with body mass index (BMI) alone, increased central adiposity, including among individuals with a BMI in the normal and overweight range, is a better predictor of cardiovascular risk, according to a news release from the American College of Cardiology (ACC). The study, which was published in the Journal of the American College of Cardiology, found that not accounting for waist circumference (WC) or waist-to-hip ratio (WHR) can lead to misclassification of cardiovascular disease (CVD) risk. “Indeed, it appears that WC and WHR reclassify risk defined by traditional BMI thresholds,” said Michael J Blaha, MD, MPH, senior author of the study, in the news release. “We saw individuals with clinically determined normal weight who had elevated central adiposity and high WHR, associating them with higher risk across most outcomes.” Researchers sought to determine if adding WC and WHR to BMI better predicted future cardiovascular risk. The analysis included more than 260,000 individuals over an average time period of 20 years who had WC or WHR data and at least 1 of the 9 following outcomes: Time to first fatal and nonfatal myocardial infarction; Fatal and nonfatal stroke; Heart failure; Atrial fibrillation; Total coronary heart disease (CHD); Total CVD; CHD mortality; CVD mortality; and/or, All-cause mortality.7nbsp;Among participants with “normal” weight based on BMI, 5% had high WC and 18% had high WHR. Of those with overweight, 39% had high WC and 40% had high WHR. Among participants with obesity, 9% had low WC and 45% had low WHR. We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings. Normal weight or overweight and clinically defined high WC or WHR were associated with a 15% to 50% increased risk for most of the 9 outcomes. Individuals with obesity and low WC, compared with those with “normal” weight, did not have a significantly different risk for outcomes, except for all-cause mortality, in which the risk was significantly decreased. A limitation of this study is that it did not include measures of physical activity, diet, or genetic obesity risk, which have a role in the development of CVD. In addition, only 1 assessment of WC and WHR was included, which may limit understanding of how changes in central fat accumulation over time affect the risk of CVD. “Our findings emphasize the critical role of identifying elevated central adiposity, even in individuals with a normal BMI or with a BMI in the overweight range,” said Zeina A Dardari, PhD, MS, lead author, in the news release. “Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes. We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings.”
References:
Abdominal fat predicts heart disease risk better than BMI. News Release. Washington, DC: American College of Cardiology; August 11, 2026. https://www.acc.org/About-ACC/Press-Releases/2026/08/11/14/59/Abdominal-Fat-Predicts-Heart-Disease-Risk-Better-Than-BMI
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