Findings from a longitudinal analysis of the ARIC study highlight the prognostic advantage of cumulative waist-to-height ratio (WHtR) over body mass index (BMI) for predicting cardiovascular outcomes. The study was presented at the European Society of Cardiology Congress 2025.

The analysis included 2,679 adults (mean age 53.7 years; 59.4% male) with obesity (BMI ≥30 kg/m²) and complete serial anthropometric data from 1987 to 1998. Cumulative adiposity burden was quantified as the area under the curve for BMI and WHtR, and participants were followed for major adverse cardiovascular events (MACE) through 2019.

Over a mean follow-up of 191 months, participants in the highest quartile of WHtR burden had a 60% higher MACE risk (HR 1.60; 95% CI 1.25–2.06), compared with a 52% increase for those in the top BMI quartile. WHtR also demonstrated superior model discrimination (C-statistic 0.57 vs. 0.56; P < .01).

These results validate the 2025 consensus emphasizing WHtR over BMI and underscore the value of central obesity assessment in improving cardiovascular risk stratification and preventive care.