Waist-to-height ratio emerges as strong predictor of heart failure risk

Waist-to-height ratio predicts heart failure incidence, according to research presented today at Heart Failure 2025, a scientific congress of the European Society of Cardiology (ESC). 

Obesity affects a substantial proportion of patients with heart failure (HF) and it has been reported that the risk of HF increases as body mass index (BMI) increases. Study presenter, Dr. Amra Jujic from Lund University, Malmö, Sweden, explained why the current analysis was carried out: "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. 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. We conducted this analysis to investigate the relationship between WtHR and the development of HF." 

The study population consisted of 1,792 participants from the Malmö Preventive Project. Participants were aged 45–73 years at baseline and were selected so that approximately one-third had normal blood glucose levels, one-third had impaired fasting glucose and one-third had diabetes. All participants were followed prospectively for incident HF. 

The study population had a mean age of 67 years and 29% were women. The median WtHR was 0.57 (interquartile range, 0.52–0.61). 

During the median follow-up of 12.6 years, 132 HF events occurred. Higher WtHR was associated with a significantly increased risk of incident HF (hazard ratio [HR] per one standard deviation increase 1.34; 95% confidence interval [CI] 1.12–1.61; p=0.001), independent of confounders. When WtHR was categorised into quartiles, individuals with the highest values of WtHR (median of 0.65) had a significantly higher risk of HF compared with individuals in the other three quartiles (HR 2.71; 95% CI 1.64–4.48; p<0.001). 

The median WtHR in our analysis was considerably higher than 0.5, the cut-off for increased cardiometabolic risk. Having a waist measurement that is less than half your height is ideal."

Dr. John Molvin, Study Co-Author, Lund University and Malmö University Hospital, Sweden

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."