Waist-to-Height Ratio versus BMI: Which is a Better Predictor of Heart Health? Study Finds Out

New Delhi: Waist-to-height ratio is a more accurate predictor of heart failure than body mass index (BMI), according to new research presented at Heart Failure 2025, a scientific congress of the European Society of Cardiology. The study found that individuals with a higher waist-to-height ratio had a significantly increased risk of developing heart failure, suggesting that the waist-to-height ratio may be a better tool than BMI for identifying patients who could benefit from obesity-related interventions.

The research analyzed data from 1,792 participants in the Malmö Preventive Project. Participants were aged 45–73 at the start of the study and included a balanced distribution of individuals with normal blood glucose, impaired fasting glucose, and diabetes. Over a median follow-up period of 12.6 years, 132 participants developed heart failure.

The study found that a higher waist-to-height ratio was associated with a significantly greater risk of heart failure. For each standard deviation increase in waist-to-height ratio, the hazard ratio for incident heart failure was 1.34, even after adjusting for potential confounders. When categorized into quartiles, individuals in the highest waist-to-height ratio group had nearly three times the risk of heart failure compared to those in the lower three quartiles.

Unlike BMI, which does not account for fat distribution and is influenced by sex and ethnicity, the waist-to-height ratio specifically reflects central adiposity — fat accumulation around vital organs — which is particularly harmful. Notably, while high BMI has sometimes been linked to unexpectedly better heart failure outcomes, this so-called “obesity paradox” was not observed with the waist-to-height ratio.

Study co-author, Dr. John Molvin from Lund University and Malmö University Hospital, Sweden, noted: “The European Society of Cardiology, Dr. John Molvin, Lund University, Malmö University Hospital, Sweden, obesity, body mass index dian The waist-to-height ratio in our analysis was considerably higher than 0.5, the cutoff for increased cardiometabolic risk. Having a waist measurement that is less than half your height is ideal.” He concluded, “We found that waist-to-height ratio was a significant predictor of incident heart failure, and our results suggest that waist-to-height ratio may be a better metric than BMI to identify patients with heart failure who could benefit from therapies for obesity. Our next step is to investigate whether the waist-to-height ratio predicts incident HF and also other cardiometabolic disorders in a larger cohort.”

Reference: https://www.escardio.org/Congresses-Events/Heart-Failure/About-the-congress