Waist-to-Height Ratio Shown to Predict Heart Failure Risk, Suggests ESC 2025 Study
A new study presented at Heart Failure 2025, the annual congress of the European Society of Cardiology (ESC), highlights the waist-to-height ratio (WtHR) as a significant predictor of heart failure (HF). The findings suggest that WtHR may offer a more reliable assessment of risk compared to the traditionally used body mass index (BMI).
“While BMI is commonly used to measure obesity, it doesn’t reflect fat distribution and is influenced by factors such as sex and ethnicity,” said Dr. Amra Jujic of Lund University in Malmö, Sweden, who led the research. “WtHR is a better indicator of central obesity — the accumulation of fat around internal organs — which is known to be more harmful.”
The analysis included 1,792 individuals aged between 45 and 73 years from the Malmö Preventive Project. Participants were grouped based on blood glucose levels: normal, impaired fasting glucose, and diabetic. They were monitored over a median period of 12.6 years to track the onset of heart failure.
At the start of the study, the participants had a median WtHR of 0.57 (IQR 0.52–0.61), and 29% were women. Over the follow-up period, 132 heart failure cases were recorded. The data revealed that higher WtHR levels significantly increased the risk of developing heart failure. Specifically, each standard deviation increase in WtHR was associated with a 34% higher risk (HR 1.34; 95% CI 1.12–1.61; p=0.001), even after adjusting for confounding variables.
Further, when grouped into quartiles, individuals in the highest WtHR category (median 0.65) faced more than double the risk of heart failure compared to those in the lower three quartiles (HR 2.71; 95% CI 1.64–4.48; p<0.001).
“Our median WtHR was well above the 0.5 threshold typically used to define elevated cardiometabolic risk,” noted Dr. John Molvin, co-author of the study and a researcher at both Lund University and Malmö University Hospital. “Ideally, your waist should measure less than half of your height.”
Dr. Molvin emphasized that the results support the use of WtHR as a more effective tool than BMI in identifying heart failure risk among obese individuals. “Our findings indicate WtHR could be valuable in selecting patients who might benefit from obesity-targeted interventions. We now plan to examine whether WtHR also predicts other cardiometabolic conditions in larger populations.”
