A recent study published in the Journal of the American College of Cardiology underscores the significance of waist size as an indicator of heart disease risks that body mass index (BMI) may overlook.

Researchers analysed data from nearly 260,000 adults across 15 long-term studies, tracking participants for approximately 20 years. The study focused on the relationship between body fat distribution and cardiovascular outcomes such as heart attacks, strokes, heart failure, irregular heart rhythms, and cardiovascular-related deaths.

Key Findings

  • Individuals with normal or overweight BMI but larger waist circumferences or higher waist-to-hip ratios faced a 15 to 50 percent increased risk of heart-related problems and mortality.
  • Visceral fat—fat stored deep in the abdomen surrounding vital organs—can contribute to inflammation, insulin resistance, and vascular issues, elevating cardiovascular risk.
  • BMI alone does not account for fat distribution, meaning people with similar BMI values can have vastly different health risks depending on abdominal fat levels.

Experts note that waist measurements provide additional insight beyond weight and height calculations, offering a clearer picture of cardiovascular health risks. However, the study's limitations include lack of data on participants' physical activity, diet, genetic factors, and changes in waist size over time.

The findings advocate for healthcare providers to incorporate waist circumference assessments alongside BMI to better identify individuals at risk of heart disease, even if they appear to have a healthy weight.

Supporting Research

  • A 2025 study in the Journal of Clinical Medicine linked waist-to-height ratio strongly with cardiometabolic risk.
  • Another large-scale 2025 study found waist-based metrics enhanced disease risk prediction, especially for non-obese individuals by BMI.
  • Additional research associated higher waist-to-height ratios with increased cardiovascular mortality and other serious health issues.

This growing body of evidence highlights the critical role of abdominal fat in cardiovascular health and suggests that relying solely on BMI may mask significant risks.