Waist-to-Height Ratio Tops BMI in Predicting Heart Failure

A person’s waist-to-height ratio (WtHR) predicts their risk for heart failure (HF), according to a study presented at Heart Failure 2025.

Obesity has a profound impact on patients with HF and researchers report that the risk for HF increases in tandem with BMI, yet BMI does not account for all fat distribution. “BMI is the most common measure of obesity, but it is influenced by factors such as sex and ethnicity and does not take into account the distribution of body fat,” said study presenter Dr. Amra Jujic from Lund University, Malmö, Sweden. “Waist-to-height ratio (WtHR) is considered a more robust measure of central adiposity, the harmful deposition of fat around visceral organs. In addition, whereas BMI is associated with paradoxically good HF outcomes with high BMI, this is not seen with WtHR.”

This study consisted of 1,792 participants (mean age, 67 years; 29% women) from the Malmö Preventive Project. The population of interest was 45 to 73 years of age at study baseline. One-third of the population had normal blood glucose levels, one-third had an elevated fasting glucose level, and a further one-third had diabetes. The full population was followed up prospectively in terms of HF.

The findings showed that a higher WtHR was correlated with a notably higher risk of incident HF (hazard ratio, 1.34; 95% CI, 1.12-1.61; P=0.001), independent of confounders, the researchers noted.

Study co-author, Dr. John Molvin from Lund University and Malmö University Hospital, Sweden, stated of the findings: “The median WtHR 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 WtHR was a significant predictor of incident HF, and our results suggest that WtHR may be a better metric than BMI to identify patients with HF who could benefit from therapies for obesity. Our next step is to investigate whether WtHR predicts incident HF and also other cardiometabolic disorders in a larger cohort.”

ESC Heart Failure 2025.