Central Adiposity Improves Cardiovascular Risk Assessment Beyond BMI

Waist circumference (WC) and waist-to-hip ratio (WHR) identified important differences in cardiovascular disease (CVD) risk that were not captured by conventional BMI categories, suggesting that central adiposity can reclassify CVD risk across normal weight, overweight, and obesity and provide additional diagnostic and prognostic information. The US Cross-Cohort Collaboration study included 259,388 participants from 15 cohorts, with a median follow-up of 20.0 years, and evaluated nine outcomes, including myocardial infarction, stroke, heart failure, atrial fibrillation, coronary heart disease, CVD, coronary heart disease mortality, CVD mortality, and all-cause mortality. Among individuals with normal weight, 5% had high WC and 18% had high WHR, while among those with overweight, 39% had high WC and 40% had high WHR, demonstrating substantial discordance between BMI and central adiposity. Among individuals with obesity, 9% had low WC and 45% had low WHR. In people with normal weight or overweight, clinically defined high WC or WHR was associated with a 15%–50% higher risk for most outcomes. Among those with obesity, low WC was generally not associated with significantly different risk compared with normal weight and low WC, except for all-cause mortality, for which the risk was significantly lower. In contrast to men, women with obesity but low WHR still had significantly higher risks for all outcomes compared with women with normal weight and low WHR, although these risks were lower than those among women with obesity and high WHR. Among individuals with obesity, the population attributable risk associated with elevated WC or WHR ranged from 13% to 49%, with the highest estimates observed for elevated WC in heart failure and atrial fibrillation. Overall, WC and WHR can identify misclassification of conventional BMI categories and add diagnostic and prognostic value to CVD risk assessment. Source: https://www.jacc.org/