What Your Waist Size Says About Your Heart Health

woman measuring was it size with yellow measuring tape

When we talk about excess weight, and in particular obesity, the body mass index or BMI is almost universally used. The BMI offers an easy way to calculate whether you are considered underweight, normal, overweight, or obese. Using these classifications, we can get a pretty good idea of who is at risk of the disease associated with morbid obesity, including cardiovascular disease. However, these BMI thresholds and classifications are ultimately arbitrary; in other words, not all patients with the same BMI will have the same risks or symptoms.

As a result, there is ongoing research into refining the BMI into a tool that can better approximate the risk of disease associated with excess weight. Until that is achieved, waist size and waist-to-hip ratio (a measure of where patients hold their extra body fat) can be a far better predictor of heart disease than BMI. Men with a waist size of 40 or more and women with a waste of 35 or more have been correlated with a significantly higher risk of heart disease, and this correlation is somewhat independent of BMI.¹

Further Refining These Results

As study authors delved more deeply into the research, it became evident that women with a bigger waist-to-hip ratio experienced a greater risk for heart attack than men with similar proportions. So, not only does a larger waist increase the risk of heart disease, but women with larger waists, when compared to their hips, are at greater risk than their male counterparts.

Where the BMI Falls Short

As mentioned above, the body mass index is an arbitrary measure of excess weight, and it does not account for gender, muscle tone, body structure, and other critical considerations. As such, we see patients with a relatively higher BMI and fewer comorbidities and vice versa.

Why This Study is Important

This study will hopefully educate patients and medical practitioners alike to look beyond BMI as a tool and screen patients using other, more reliable criteria. This will get patients to their cardiologist or electrophysiologist sooner and get treatment started when the most comprehensive array of options is available.

From an electrophysiologist’s standpoint, we know that visceral abdominal fat is also problematic for heart rhythm. This fat requires additional blood vessels, which forces the heart to pump harder and thus increases blood pressure. Blood pressure and atrial fibrillation, as well as other arrhythmias, are inextricably linked. This knowledge can also allow primary care physicians to educate their patients on what to look out for if they ever develop a cardiac arrhythmia.

The Bottom Line

We are always looking to treat atrial fibrillation early as later stages of the condition make medical and procedural treatment options less effective and more unpredictable. By screening patients based on their waist size and waist-to-hip ratio, we can get them proper cardiovascular screening sooner, reduce morbidity and hopefully save lives.


  1. Peters SAE, Bots SH, Woodward M. Sex Differences in the Association Between Measures of General and Central Adiposity and the Risk of Myocardial Infarction: Results From the UK Biobank. J Am Heart Assoc. 2018 Feb 28;7(5):e008507. doi: 10.1161/JAHA.117.008507. PMID: 29490971; PMCID: PMC5866342.

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