Abdominal fat distribution may provide a more accurate measure of cardiovascular risk than body mass index (BMI) alone, according to findings from the FINE-HEART pooled analysis published in the Journal of the American College of Cardiology. The study combined data from FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF, evaluating the relationship between adiposity, cardiovascular outcomes, and the treatment effects of finerenone in individuals with CKM disease.

Among 18,759 participants with complete anthropometric data, 52% had obesity (BMI ≥30 kg/m²), and 98% had some degree of excess adiposity. Notably, 95% of participants with normal BMI also had increased abdominal fat. Higher BMI, WC, WHtR, and WHR were each independently associated with adverse cardiovascular outcomes, including cardiovascular death, HF hospitalization, and major adverse cardiovascular events. Participants with both elevated BMI and WHtR had the highest event rates (P < 0.001).

Treatment with finerenone significantly reduced the risk of cardiovascular death or HF hospitalization consistently across all adiposity levels (P_interaction > 0.25). Absolute benefits were greater among those with higher abdominal adiposity. Serious adverse events were less frequent in the finerenone group, irrespective of baseline BMI category.

These results emphasize that assessing abdominal adiposity alongside BMI can improve obesity identification and cardiovascular risk prediction in CKM disease. Finerenone provided consistent cardioprotective benefits across the full adiposity spectrum, underscoring its therapeutic value in this high-risk population.