Washington (Aug. 11, 2026) – A study published in the Journal of the American College of Cardiology reported that waist circumference provides a more accurate assessment of cardiovascular disease risk than body mass index (BMI) alone. The research analyzed data from more than 260,000 adults followed for an average of 20 years and evaluated nine cardiovascular outcomes, including heart attack, stroke, heart failure and all‑cause mortality.

Researchers found that among individuals classified as normal weight or overweight by BMI, 5% had elevated waist circumference and 18% had elevated waist‑to‑hip ratio, while 39% of overweight participants and 40% of those with obesity exhibited high waist circumference. In these groups, the risk of major cardiovascular events was 15% to 50% higher compared with participants who had normal waist measurements. In people with obesity and low waist circumference, risk was not significantly different from normal‑weight individuals with low waist circumference, except for all‑cause mortality, which was lower.

Michael J. Blaha, MD, MPH, senior author and director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, said the findings indicate that central adiposity should be considered regardless of BMI. Zeina A. Dardari, PhD, MS, lead author, emphasized that relying solely on BMI may misclassify cardiovascular risk across a broad range of outcomes. Harlan M. Krumholz, MD, SM, editor‑in‑chief of the journal and professor at Yale School of Medicine, noted that the large cohort study validates the importance of waist circumference and waist‑to‑hip ratio in primary prevention.

The study did not account for physical activity, diet or genetic predisposition to obesity, and it used a single measurement of waist circumference and waist‑to‑hip ratio, limiting insight into how changes over time affect risk. Clinicians are encouraged to incorporate these simple measurements into routine cardiovascular risk assessments, though current guidelines do not yet require this practice.