Excess weight is a known risk factor for heart disease. Recent evidence suggests that the location of the extra body fat may matter more than overall weight. People with too much fat around the midsection — abdominal fat — face the greatest increased risk for heart disease. The standard body mass index (BMI) method for determining normal weight, overweight, and obesity can’t tell where fat is stored.
A study published in the August 11, 2026 issue of the Journal of the American College of Cardiology tested whether waist circumference and waist-to-hip ratio improve estimates of heart disease risk. Researchers pooled data from 15 long-running studies in the United States and Brazil, which included over 259,000 adults with no known heart disease. They followed them for about 20 years looking for heart disease–related outcomes, such as heart attack, stroke,heart failure, atrial fibrillation, and death.
Among people with a normal BMI, 5% had a high waist circumference and 18% had a high waist-to-hip ratio. Among those with overweight, 39% had a high waist circumference and 40% had a high waist-to-hip ratio. Among people with obesity, 9% had a low waist circumference and 45% had a low waist-to-hip ratio.
Those measurements mattered when it came to heart disease risk. Among people who were normal weight or overweight but had a high waist circumference or high waist-to-hip ratio, risks for most of the heart disease outcomes were 15% to 50% higher than such risks among those with normal weight and low waist measurements. Heart-related risks among people with obesity but a small waist were no higher than the risks for people with normal weight.
You can work to reduce abdominal fat with at least 150 minutes of moderate-intensity physical activity per week and following a heart-healthy diet.
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