waist hip ratio (WHR) and cardiovascular disease (CVD)

Last reviewed 09/2022

Waist hip ratio (WHR) is a measure that helps discriminate abdominal obesity from overall obesity.

In a study situation WHR was measured (1) via:

• measurement of waist circumference - measured btweeen the lower border of the ribs, and the iliac crest in a horizontal plane
• measurement of hip circumference - measured at the widest point over the buttocks
• WHR was obtained by dividing the mean waist circumference by the mean hip-circumference
  • men with a WHR 0.90-0.99 and women with a WHR 0.80-0.84 were classified as overweight
  • men with a WHR 1.00 and women with a WHR 0.85 were classified as obese

WHR has shown to independently predict death from cardiovascular disease and coronary heart disease in Austrialina men and women (1).

• the study authors observed that the unadjusted associations with each of the CVD risk factors in both male and female subjects were strongest for obesity when defined using WHR (rather than other obesity measures - body mass index, waist circumference)

A commentary on this study stated that "most of the literature supports the finding that abdominal obesity is a stronger risk factor for cardiovascular disease than overall obesity. However, whether WHR is independent of traditional cardiac risk factors remains controversial and unanswered by this study " (2).

A more recent meta-analysis concluded that wist circumference and waist-to-hip ratio increase risk of cardiovascular events in men and women (3).

WHR shows a linear association with mortality in middle-aged men and women, but body mass index, based on this particular study, did not (4)

Reference:

• (1)Welborn TA et al. Waist-hip ratio is the dominant risk factor for predicting cardiovascular death in Australia. Med J Aust 2003;179:580-5
• (2) Evidence-Based Medicine (2004); 9(4): 125.
• (3) de Koning L et al. Waist circumference and waist-to-hip ratio as predictors of cardiovascular events: meta-regression analysis of prospective studies.Eur Heart J. 2007 Apr;28(7):850-6
• (4) Simpson JA et al. A comparison of adiposity measures as predictors of all-cause mortality: the Melbourne Collaborative Cohort Study.Obesity (Silver Spring). 2007 Apr;15(4):994-1003.