With the link between weight and risk of myocardial infarction (MI) fairly well established, clinicians have sought simple measures to help assess specific risk for individual patients. Popular means of evaluating unhealthy weight have included the body mass index (BMI) and set cutoff points based on waist measurement (such as a waist measurement of >40 inches indicating increased risk for a man).
But now, a subanalysis of data from the INTERHEART study, a worldwide case-controlled study of modifiable risk factors associated with MI (Yusuf et al. Lancet. 2004;364:937-952), suggests that the waist-to-hip ratio is superior to traditional body size measurements as a risk assessment tool, offering a graded and highly significant association with MI risk. The investigators went on to state that the waist-to-hip ratio (calculated by dividing the waist measure by the hip measure) is 3 times stronger than BMI in predicting risk for MI (Yusuf et al. Lancet. 2005;366:1640-1649). The researchers found that a waist-to-hip ratio of 0.85 or higher for women and 0.90 and up for men effectively constituted an additional risk factor. INTERHEART enrolled 27 098 participants in 52 countries, representing major ethnic groups.
Mitka M. Obesity's Role in Heart Disease Requires Apples and Pears Comparison. JAMA. 2005;294(24):3071-3072. doi:10.1001/jama.294.24.3071