Prevention & lipidsCohort study
Risk Reclassification Beyond Body Mass Index (BMI) by Waist Circumference and Waist-to-Hip Ratio Across 9 Cardiovascular Outcomes
- Pooled cohort analysis
- 15 cohorts
- multivariable Cox proportional hazards models
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
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 |
| High WHR | 18% | 40% | Not reported in the abstract |
| Low WC | Not reported in the abstract | Not reported in the abstract | 9% |
| Low WHR | Not reported in the abstract | Not reported in the abstract | 45% |
- 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. J Am Coll Cardiol. Published 11 August 2026. doi:10.1016/j.jacc.2026.05.050
Summarised from the published abstract; every number is checked against it