Waist-to-height ratio (WHtR) provided additional risk stratification for cardiovascular outcomes and mortality in type 2 diabetes mellitus (T2DM) beyond traditional anthropometric measures. A population-based cohort study published in Diabetes, Obesity and Metabolism evaluated the association between WHtR and incident myocardial infarction, stroke, and all-cause mortality in individuals with T2DM.

The analysis included 2,076,104 adults with T2DM who underwent a national health checkup in Korea between 2015 and 2016 and were followed through 2022. Multivariable Cox proportional hazards models were used to examine associations between WHtR and outcomes, with restricted cubic spline analyses assessing dose-response relationships and additional stratification by abdominal obesity.

During follow-up, 125,493 deaths (6.0%), 56,280 myocardial infarctions (2.7%), and 62,938 strokes (3.0%) were recorded. Higher WHtR values were associated with increased risk of myocardial infarction and stroke, while a U-shaped relationship was observed with all-cause mortality.

Individuals with both abdominal obesity and WHtR ≥0.5 had higher risks of myocardial infarction (hazard ratio [HR] 1.12; 95% confidence interval [CI] 1.07-1.17), stroke (HR 1.18; 95% CI 1.15-1.21), and mortality (HR 1.20; 95% CI 1.16-1.25). Among individuals without abdominal obesity, WHtR ≥0.5 was also associated with increased cardiovascular risk but slightly lower mortality, whereas those with abdominal obesity but normal WHtR showed no significant increase in risk. 

Associations were more pronounced for cardiovascular outcomes in younger individuals and those with newly diagnosed T2DM, while mortality associations were stronger in individuals with longer disease duration. WHtR ratio was associated with cardiovascular outcomes and mortality in T2DM, including among individuals without abdominal obesity.