Risk Reclassification Beyond Body Mass Index (BMI) by Waist Circumference and Waist-to-Hip Ratio Across 9 Cardiovascular Outcomes: Results From the Cross-Cohort Collaboration
Authors' conclusion
WC and WHR identifies misclassification of conventional BMI categories and reclassifies CVD risk across normal weight, overweight, and obesity, adding diagnostic and prognostic value.
Study context
- Population
- Participants of 15 cohorts of the Cross-Cohort Collaboration (CCC) with harmonized waist circumference (WC) or waist-to-hip ratio (WHR) data
- Participants
- 259,388 participants · 15 cohorts
- Exposure
- High vs low WC and WHR across BMI categories
- Outcome
- Reclassification and misclassification of BMI categories by central adiposity (WC, WHR), and associated risk of 9 CV outcomes (MI, stroke, HF, AF, total CHD, total cardiovascular disease (CVD), CHD mortality, CVD mortality, all-cause mortality)
- Follow-up
- Median 20.0 years
Methodological details15 cohorts, multivariable Cox proportional hazards models
- 15 cohorts
- Multivariable Cox proportional hazards models
Main finding
As reported in the abstract
High WC / high WHR by BMI category
| Outcome | Normal weight | Overweight | Obesity | |
|---|---|---|---|---|
| High WC | 5% | 39% | Not reported in the abstract | Obesity: not reported in the abstract |
| High WHR | 18% | 40% | Not reported in the abstract | Obesity: not reported in the abstract |
| Low WC | Not reported in the abstract | Not reported in the abstract | 9% | Normal weight, Overweight: not reported in the abstract |
| Low WHR | Not reported in the abstract | Not reported in the abstract | 45% | Normal weight, Overweight: not reported in the abstract |
- Normal weight or overweight: high WC or WHR associated with greater risk for most outcomes
- 15% to 50%
Observational data: associations, not effects.
Further findings
Population attributable risk of elevated WC or WHR (obesity)
- PAR range; highest for elevated WC in HF and AF
- 13% to 49%
Original publication
Risk Reclassification Beyond BMI by Waist Circumference and Waist-to-Hip Ratio Across 9 Cardiovascular Outcomes: Results From the Cross-Cohort Collaboration. J Am Coll Cardiol. Published 11 August 2026. doi:10.
Summarised from the published abstract; every number is checked against it