BMI alone is not enough: Abdominal fat plays crucial role when assessing heart disease risk
Michael Walter|August 11, 2026|Cardiovascular Business|Heart Health
Abdominal fat is a more accurate predictor of heart disease than body mass index (BMI) alone, according to new findings published in JACC.[1]
BMI remains the most common way that clinicians determine if an individual is overweight or obese. The team behind this new analysis hoped to learn if taking waist circumference (WC) and waist-to-hip ratio (WHR) into account could lead to better assessments of a person’s risk of developing cardiovascular disease (CVD).
The study included data from more than 260,000 adults over the age of 20 years old. The median follow-up period was 20 years.
Among patients with a normal weight as determined bv BMI, 5% had a high WC and 18% had a higher WHR. Among overweight patients, 39% had a high WC and 40% had a high WHR. Finally, among obese patients, 9% had a low WC and 45% had a low WHR
Why do so many patients with a normal weight have a high WC or WHR? And why are there so many obese patients with a low WC or low WHR? This suggests that BMI alone is not providing the best evaluation of a person’s cardiovascular health.
“Our findings emphasize the critical role of identifying elevated central adiposity, even in individuals with a normal BMI or with a BMI in the overweight range. Relying solely on BMI may result in misclassification of cardiovascular risk across a wide range of cardiovascular outcomes,” lead author Zeina A. Dardari, PhD, MS, a researcher with the Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease (CCPCD), said in a statement. “We encourage clinicians to consider central adiposity distribution across the entire BMI spectrum when evaluating cardiovascular risk in primary prevention settings.”
“Indeed, it appears that WC and WHR reclassify risk defined by traditional BMI thresholds,” added Michael J. Blaha, MD, MPH, senior author of the study and director of clinical research at the Johns Hopkins CCPCD. “We saw individuals with clinically determined normal weight who had elevated central adiposity and high WHR, associating them with higher risk across most outcomes.”
Harlan M. Krumholz, MD, SM, editor-in-chief of JACC and a professor at the Yale School of Medicine, shared his own perspective on the research team’s findings
“It is time to abandon a sole focus on BMI,” he said. “This enormously important study, based on data from hundreds of thousands of participants in large-scale cohort studies, authoritatively shows that waist circumference and waist-to-hip ratio provide critical information about cardiovascular risk, even among people with a BMI considered normal. Where fat is distributed matters, and these simple measures should be part of routine cardiovascular risk assessment.”
Click here to read the full analysis in JACC, the flagship journal of the American College of Cardiology
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Michael Walter, Managing Editor
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics
