New research presented at Heart Failure 2025 reveals that waist-to-height ratio offers superior prediction of heart failure risk compared to traditional body mass index measurements. The study, conducted by researchers at Lund University in Sweden, suggests that where fat is distributed on the body matters more than overall weight when assessing cardiovascular health risks.
The findings, presented today at the European Society of Cardiology’s scientific congress in Belgrade, Serbia, could have significant implications for how doctors screen patients for heart failure risk.
Beyond BMI: A Better Measure of Harmful Fat
For decades, body mass index (BMI) has been the standard measurement for obesity in clinical settings. However, it fails to account for where fat accumulates on the body—a crucial distinction when assessing health risks.
“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,” explained Dr. Amra Jujic from Lund University, who presented the study. “Waist-to-height ratio is considered a more robust measure of central adiposity, the harmful deposition of fat around visceral organs.”
This central adiposity—essentially fat accumulated around the abdomen and internal organs—is particularly dangerous compared to fat distributed elsewhere on the body.
The Study: Following Patients for Over a Decade
The research team followed 1,792 participants from the Malmö Preventive Project for a median of 12.6 years. Participants ranged in age from 45 to 73 years at the beginning of the study, with researchers strategically selecting individuals so that approximately equal thirds had normal blood glucose levels, impaired fasting glucose, or diabetes.
During the follow-up period, 132 participants developed heart failure. When analyzing the data, researchers found that higher waist-to-height ratios were significantly associated with increased heart failure risk, even after adjusting for other factors.
The numbers tell a compelling story:
- For each standard deviation increase in waist-to-height ratio, heart failure risk increased by 34%
- Participants in the highest quartile of waist-to-height ratio (median of 0.65) had 2.7 times greater risk of developing heart failure compared to those in the lower three quartiles
- The median waist-to-height ratio in the study population was 0.57—notably higher than the recommended cutoff of 0.5
When Is Your Waist Too Large?
What makes the waist-to-height ratio particularly useful is its simplicity. Unlike BMI, which requires a calculation based on weight and height, the waist-to-height guideline is straightforward.
“Having a waist measurement that is less than half your height is ideal,” noted study co-author Dr. John Molvin from Lund University and Malmö University Hospital.
For example, a person who is 5’8″ (68 inches) tall should aim for a waist circumference less than 34 inches to maintain a healthy ratio below 0.5.
Why Does This Measurement Matter?
The significance of this research extends beyond just providing another health metric. It may change how physicians identify patients who could benefit from targeted interventions.
Interestingly, previous research has shown a paradoxical relationship between BMI and heart failure outcomes—some studies suggest patients with higher BMI sometimes fare better after developing heart failure, a phenomenon not observed with waist-to-height measurements.
The study’s findings suggest that waist-to-height ratio could be particularly valuable for identifying patients who might benefit from obesity treatments specifically designed to reduce heart failure risk.
Could measuring the waist become as routine as checking blood pressure during physical exams? Research like this suggests it perhaps should be.
Looking Forward
The research team isn’t stopping here. “Our next step is to investigate whether waist-to-height ratio predicts incident heart failure and also other cardiometabolic disorders in a larger cohort,” Dr. Molvin said.
These findings arrive at a critical time, as heart failure affects millions worldwide and obesity rates continue to climb globally. Having more precise tools to identify those at highest risk could help clinicians intervene earlier with preventive strategies.
For the average person, the message seems clear: paying attention to waist circumference relative to height—not just overall weight—may provide important clues about heart health risks. While BMI offers some insights, where the body carries fat appears to matter significantly more than previously recognized in clinical practice.
As researchers continue exploring this relationship, the simple measurement of comparing waist circumference to height could become an increasingly important part of routine health assessments and heart failure prevention strategies.
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