A new study presented at the Heart Failure 2025 congress of the European Society of Cardiology (ESC) highlights the waist-to-height ratio (WtHR) as a more accurate predictor of heart failure than the widely used body mass index (BMI).
Researchers from Lund University in Malmö, Sweden, led the investigation. Dr. Amra Jujic, the presenting author, explained the motivation behind the study: “BMI is the most common way to measure obesity, but it has its flaws. It doesn’t show where fat is located in the body and can be affected by factors like gender and ethnicity. In contrast, WtHR focuses on central fat, which is the fat around vital organs and considered more harmful.”
Dr. Jujic added that while higher BMI is sometimes linked to better outcomes in heart failure, this pattern doesn’t hold when using WtHR. This made WtHR a better candidate for predicting who might develop heart failure.
Study Details
The researchers analyzed data from 1,792 individuals who were part of the Malmö Preventive Project. At the start, participants were between 45 and 73 years old. They were grouped based on blood sugar levels: about one-third had normal levels, one-third had slightly high levels, and one-third had diabetes.
The group had a median age of 67 years, and 29% were women. The average waist-to-height ratio was 0.57, which is above the 0.5 level that signals increased risk for heart and metabolic problems.
Over an average follow-up period of 12.6 years, 132 participants developed heart failure. The results showed that as WtHR increased, so did the risk of heart failure.
Specifically, for every standard deviation increase in WtHR, the risk of developing heart failure rose by 34%—even after adjusting for other risk factors. Those in the highest WtHR group (with a median of 0.65) were nearly three times more likely to develop heart failure compared to those in the lower three groups.
A Simple Rule: Waist Less Than Half Your Height
Study co-author Dr. John Molvin, also from Lund University and Malmö University Hospital, emphasized the practical message: “In our study, the average waist-to-height ratio was well above 0.5. Ideally, your waist should be less than half your height. This simple rule can help people understand their risk.”
What Comes Next
Dr. Molvin concluded, “WtHR was a clear and significant predictor of new heart failure cases. These findings suggest that WtHR may be a more reliable tool than BMI when it comes to identifying people with heart failure who might benefit from obesity treatments.”
He added that their next step is to test whether WtHR can also predict other heart and metabolic diseases in larger groups of people.
