Excess fat around the abdomen is a more accurate warning sign for heart failure risk than general body weight, according to significant new medical research. Radiologists in Germany have established a clear link between a high waist-to-hip ratio and physical changes to the heart's structure that precede serious cardiac events.
Why Your Waist-to-Hip Ratio Matters More Than Your Weight
A high waist-to-hip ratio (WHR) indicates the body is storing more fat around the stomach than the hips, a condition known as abdominal obesity. Crucially, this measurement is a stronger indicator of organ health than the commonly used Body Mass Index (BMI).
A high WHR signals the presence of harmful visceral fat, which wraps around internal organs. This type of fat acts like an active gland, flooding the system with inflammatory chemicals and disrupting hormonal balance. This inflammation and imbalance directly injure the heart muscle.
The damage manifests as thickened heart walls and shrunken chambers, forcing the organ to work harder until it can no longer cope efficiently. This process significantly elevates the risk of heart disease and heart attack. Visceral fat is also linked to high blood pressure, interferes with healthy blood vessel function, and contributes to high cholesterol.
The Physical Changes Inside a Heart Under Stress
The German study, involving over 2,200 adults aged 46 to 78 with no prior heart disease diagnosis, used advanced cardiac MRI scans to observe subtle changes. Researchers found that in people with a high WHR, the lining of the heart's chambers thickened, reducing their capacity to hold blood, even as the overall heart size remained unchanged.
As the heart struggles to pump blood with this reduced capacity, the risk of heart attack, stroke, and sudden cardiac death rises sharply. Even in individuals without diagnosed heart conditions, high abdominal fat levels were tied to early, detectable changes in heart muscle and structure.
Dr Jennifer Erley, lead author from the University Medical Center Hamburg-Eppendorf, advised: ‘Rather than focusing on reducing overall weight, middle-aged adults should focus on preventing abdominal fat accumulation through regular exercise, a balanced diet and timely medical intervention, if necessary.’
Stark Differences in Obesity Measurements and Sex-Specific Risks
The research highlighted a dramatic discrepancy between BMI and WHR assessments. Using BMI, 69% of men and 56% of women in the study were classed as overweight or obese. However, when applying World Health Organization WHR criteria, the figures jumped to 91% of men and 64% of women meeting the threshold for obesity.
To calculate your WHR, measure your waist at its narrowest point and your hips at their widest, then divide the waist measurement by the hip measurement. A result above 0.90 for men or 0.85 for women indicates abdominal obesity and increased heart disease risk.
The study revealed that heart changes were more pronounced in men than women. General obesity (by BMI) was linked to enlarged heart chambers, while abdominal obesity (by WHR) was associated with thicker heart muscle and smaller chamber volumes. A thickened heart muscle has a reduced pumping capacity, causing symptoms like dizziness and breathlessness, and can lead to heart failure and dangerous abnormal rhythms.
Dr Erley suggested the greater heart damage seen in men could be due to earlier onset of severe abdominal obesity or the cardioprotective effect of estrogen in women. The biological tendency for men to store fat viscerally, and women subcutaneously (especially pre-menopause), plays a key role.
The findings, to be presented at the Radiological Society of North America's annual meeting, urge doctors to proactively check patients' visceral fat levels with the same regularity as overall weight. This shift could lead to earlier interventions and better prevention of cardiovascular disease.
