Forget BMI, measure your waist! New study finds waist-to-height ratio better at predicting heart failure

A Swedish study reveals waist-to-height ratio (WtHR) is a stronger predictor of heart failure than BMI. The findings suggest WtHR better reflects fat distribution and risk, offering a more accurate screening tool for heart issues. 

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The old tape measure might just save your heart. According to new research presented recently at Heart Failure 2025, a scientific meeting of the European Society of Cardiology, your waist-to-height ratio (WtHR) is a better predictor of heart failure than the widely used body mass index (BMI).

The study, conducted by researchers from Lund University in Malmö, Sweden, followed 1,792 participants aged between 45 and 73 years over a 12.6-year period. These individuals were part of the Malmö Preventive Project, and they had varying blood sugar levels, ranging from normal to impaired fasting glucose and to diabetes.

The key finding? A higher WtHR significantly increased the risk of developing heart failure (HF). Specifically, each standard deviation increase in WtHR was linked to a 34% higher risk of heart failure. Participants in the top quartile of WtHR with a median of 0.65 had a 2.7 times higher risk of heart failure compared to those in the lower three quartiles.

Why WtHR over BMI?

Dr. Amra Jujic, who presented the study, explained, “BMI doesn’t reflect where fat is located, and it varies with sex and ethnicity. In contrast, WtHR directly measures central fat, the kind stored around organs, which is more harmful. Interestingly, while high BMI sometimes shows a paradoxical link with better HF outcomes, this is not the case with WtHR.”

Co-author Dr. John Molvin added, "The median WtHR in our study was 0.57, much higher than the ideal cut-off of 0.5, which marks increased cardiometabolic risk. Keeping your waist below half your height should be the goal."

What other studies are saying

This isn’t the first time WtHR has been flagged as a better obesity metric. Several recent studies across Europe and Asia have shown that WtHR is more closely tied to diabetes, high blood pressure, and cardiovascular disease than BMI. A 2022 meta-analysis in Obesity Reviews even suggested that WtHR could outperform BMI and waist circumference in predicting early death due to heart problems.

Meanwhile, newer guidelines in countries like Japan and the UK have started incorporating WtHR into routine health assessments, especially in individuals with normal BMI but high visceral fat.

What’s next?

The Swedish researchers say they plan to expand their study to a larger cohort to explore whether WtHR not only predicts heart failure but also other cardiometabolic disorders like type 2 diabetes and stroke.

In the meantime, here’s a simple rule to remember: Keep your waist less than half your height.

Your heart might thank you!