From the Guidelines
Waist-to-hip ratio (WHR) is a significant predictor of cardiac prognosis, with higher ratios indicating increased cardiovascular risk, and for every 0.01 increase in WHR, there is a 5% increase in risk of cardiovascular disease (CVD) 1.
Importance of Waist-to-Hip Ratio
The measurement of WHR is crucial because it specifically assesses abdominal or central obesity, which is metabolically more dangerous than fat distributed elsewhere in the body. Abdominal fat is metabolically active, releasing inflammatory cytokines and hormones that promote insulin resistance, dyslipidemia, and endothelial dysfunction—all key factors in atherosclerosis development.
Healthy Waist-to-Hip Ratio
A healthy WHR is generally considered to be below 0.90 for men and below 0.85 for women. Individuals with elevated WHR have a substantially higher risk of cardiovascular events, including heart attacks and strokes, even when accounting for other risk factors.
Measuring Waist-to-Hip Ratio
To measure WHR correctly, divide your waist circumference (measured at the narrowest point between the lowest rib and iliac crest) by your hip circumference (measured at the widest part of the buttocks).
Reducing Cardiovascular Risk
For those with elevated WHR, targeted lifestyle interventions including regular aerobic exercise, strength training, and a diet rich in whole foods while limiting refined carbohydrates and processed foods can help reduce abdominal fat specifically. Monitoring changes in WHR over time can provide valuable feedback on cardiovascular risk reduction efforts, potentially more accurately than weight or BMI alone 1.
Key Points
- Waist-to-hip ratio is a significant predictor of cardiac prognosis.
- Higher ratios indicate increased cardiovascular risk.
- A healthy WHR is below 0.90 for men and below 0.85 for women.
- Abdominal fat is metabolically active and promotes insulin resistance, dyslipidemia, and endothelial dysfunction.
- Lifestyle interventions can help reduce abdominal fat and cardiovascular risk.
From the Research
Waist to Hip Ratio and Cardiac Prognosis
- The waist-to-hip ratio (WHR) is a significant predictor of cardiovascular disease (CVD) events, with a 0.01 U increase in WHR associated with a 5% increased risk of CVD events 2.
- A meta-regression analysis of prospective studies found that WHR was more strongly associated with CVD risk than waist circumference (WC), although the difference was not significant 2.
- An individual-participant meta-analysis of nine cohort studies found that a one standard deviation higher WHR was related to a higher risk of CVD mortality, with a hazard ratio of 1.15 (95% CI: 1.05-1.25) 3.
- The risk of CVD mortality increased linearly across quintiles of WHR, with a 66% increased risk in the highest quintile 3.
- Measures of abdominal adiposity, including WHR, were related to an increased risk of CVD mortality, while body mass index (BMI) was not associated with CVD mortality in fully adjusted models 3.
Comparison with Other Risk Factors
- Hypercholesterolemia and hypertension are common risk factors for CVD, and updated guidelines emphasize the importance of reducing overall cardiovascular risk 4.
- The renin-angiotensin system (RAS) plays a crucial role in the pathogenesis of atherosclerosis, and RAS inhibitors can improve endothelial dysfunction and insulin resistance 4.
- Combined therapy with statins and RAS inhibitors may be beneficial in reducing cardiovascular events and improving endothelial dysfunction and insulin resistance 4.
Treatment and Management
- Angiotensin-converting enzyme (ACE) inhibitors are commonly used to treat hypertension, but may be associated with side effects such as cough and angioedema 5, 6.
- Angiotensin receptor blockers (ARBs) may be an alternative to ACE inhibitors, with equal efficacy but fewer adverse events 6.
- Bioactive peptides from food may be a potential alternative therapy for hypertension treatment, targeting the RAS and other mechanisms involved in blood pressure regulation 5.