Evidence map›Paper›PMID 42583989›Full record

ArticleJournal of the American College of Cardiology2026

Risk Reclassification Beyond BMI by Waist Circumference and Waist-to-Hip Ratio Across 9 Cardiovascular Outcomes: Results From the Cross-Cohort Collaboration.

Zeina A Dardari, Zhiqi Yao, Jianjun Zhang, Giorgos Bakoyannis, Hongmei Nan, Lisa K Staten, Kunal K Jha, Erfan Tasdighi, Yara Jelwan, Semenawit Burka and 28 more

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Article in Journal of the American College of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

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5 · Who and what money

Authors and funding

38 authors.

Zeina A DardariJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA; Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
Zhiqi YaoJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
Jianjun ZhangDepartment of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
Giorgos BakoyannisDepartment of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
Hongmei NanDepartment of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
Lisa K StatenDepartment of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.
Kunal K JhaDivision of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Erfan TasdighiDepartment of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Yara JelwanJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
Semenawit BurkaJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA.
Kunihiro MatsushitaJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA; Department of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Joao A C LimaDivision of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.
Bruce M PsatyCardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
Amanda M FrettsCardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
Rozenn N LemaitreCardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Seattle, Washington, USA.
Debbie L CohenRenal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Lawrence J AppelDepartment of Epidemiology, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Amit KheraUniversity of Texas Southwestern, Division of Cardiology, Dallas, Texas, USA.
Amil M ShahUniversity of Texas Southwestern, Division of Cardiology, Dallas, Texas, USA.
Michael E HallDepartment of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Suzanne E JuddDepartment of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA.
Monika M SaffordDepartment of Medicine, Weill Medical College of Cornell University, New York, New York, USA.
Shelley A ColePopulation Health Program, Texas Biomedical Research Institute, San Antonio, Texas, USA.
Ramachandran S VasanUniversity of Texas School of Public Health, San Antonio, Texas, USA.
Emelia J BenjaminDepartment of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.
Peggy M CawthonCalifornia Pacific Medical Center Research Institute, San Francisco and Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
Eric OrwollDivision of Endocrinology, Diabetes and Clinical Nutrition, School of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
Michael J LaMonteDepartment of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York, USA.
Charles B EatonCenter for Primary Care and Prevention, Department of Family Medicine, Department of Epidemiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Samar R El KhoudaryUniversity of Pittsburgh School of Public Health, Department of Epidemiology, Pittsburgh, Pennsylvania, USA.
Elizabeth A JacksonDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Imke JanssenDepartment of Family and Preventive Medicine Rush University Medical Center, Chicago, Illinois, USA.
Paulo A LotufoCenter for Clinical and Epidemiologic Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil.
Isabela M BensenorDepartment of Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA.
Márcio Sommer BittencourtCenter for Clinical and Epidemiologic Research, Hospital Universitario, University of Sao Paulo, Sao Paulo, Brazil; Department of Medicine, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA.
Ankeet S BhattDepartment of Medicine, Stanford School of Medicine, Palo Alto, California, USA; Kaiser Permanente San Francisco Medical Center and Division of Research, San Francisco, California, USA.
Ana C RicardoDepartment of Medicine, Division of Nephrology, University of Illinois, Chicago, Illinois, USA.
Michael J BlahaJohns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland, USA. Electronic address: mblaha1@jhmi.edu.

Funding

UCSF CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTEUL1RR024131 · NCRR · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI JOHNSTON, S. CLAIBORNE · 2006 to 2011
$111.2M
VCID and Stroke in a Bi-racial National CohortU01NS041588 · NINDS · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI CUSHMAN, MARY, HOWARD, GEORGE · 2002 to 2022
$96.0M
The Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old AgeU19AG063720 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI REBECCA C THURSTON · 2020 to 2026
$61.3M
Institute for Clinical and Translational ResearchUL1TR001079 · NCATS · JOHNS HOPKINS UNIVERSITY · PI FORD, DANIEL ERNEST · 2013 to 2017
$60.1M
Scientific and Data Coordinating Center(SDCC) for the P*U01DK060990 · NIDDK · UNIVERSITY OF PENNSYLVANIA · PI FELDMAN, HAROLD I · 2001 to 2017
$50.1M
Clinical and Translational Science Collaborative of ClevelandUL1TR000439 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI KONSTAN, MICHAEL W. · 2012 to 2016
$50.0M
Michigan Institute for Clinical and Health Research (MCHR)UL1TR000433 · NCATS · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI MASHOUR, GEORGE ALEXANDER · 2012 to 2016
$49.9M
Institutional Clinical and Translational Science AwardUL1TR000003 · NCATS · UNIVERSITY OF PENNSYLVANIA · PI FITZGERALD, GARRET A · 2012 to 2015
$38.9M
WOMENS HEALTH ACROSS THE NATION--COORDINATING CENTERU01AG012553 · NIA · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI BROOKS, MARIA MORI · 1994 to 2019
$37.7M
Wake Forest Clinical and Translational Science AwardUL1TR001420 · NCATS · WAKE FOREST UNIVERSITY HEALTH SCIENCES · PI ARD, JAMY D, FOLEY, KRISTIE L · 2015 to 2023
$32.3M
Clinical and Translational Science Collaborative of Northern Ohio, Catalyzing Linkages to Equity in Health (CLE Health)UM1TR004528 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI GRACE A MCCOMSEY · 2023 to 2026
$32.1M
FRAMINGHAM HEART STUDY - YEAR 5 EXAM75N92019D00031 · NHLBI · BOSTON UNIVERSITY MEDICAL CAMPUS · PI RAMACHANDRAN, VASAN · 2019 to 2024
$29.8M
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6 · The paper itself

Abstract

backgroundBody mass index (BMI) is commonly used to assess total adiposity, yet does not provide insight into overall body composition, potentially obscuring meaningful heterogeneity in cardiovascular disease (CVD) risk. Waist circumference (WC) and waist-to-hip ratio (WHR) are surrogate measures of central adiposity that are commonly discordant with BMI and may provide additional prognostic information.

objectivesThe purpose of this study was to quantify the reclassification and misclassification of traditional normal weight/overweight/obesity categories using central adiposity and to evaluate the prognostic implications for CVD risk using the CCC (Cross-Cohort Collaboration).

methodsWe included 259,388 participants from 15 cohorts of the CCC with harmonized data on either WC or WHR data and at least 1 of 9 outcomes: time to first fatal and nonfatal myocardial infarction, fatal and nonfatal stroke, heart failure, atrial fibrillation, total coronary heart disease, total CVD, coronary heart disease mortality, CVD mortality, and all-cause mortality. Multivariable Cox proportional hazards models were used to estimate the HR of higher WC and WHR for each outcome across BMI categories.

resultsOur sample included 259,351 individuals with WC data and 218,984 with WHR data, with a median follow-up of 20.0 years (95% CI: 12.7-23.5 years). Among individuals with normal weight, 5% had high WC and 18% had high WHR; among those with overweight, 39% had high WC and 40% had high WHR. Among those with obesity, 9% had low WC and 45% had low WHR. Among individuals with normal weight or overweight, clinically defined high WC or WHR was associated with 15% to 50% greater risk for most outcomes. Among those with obesity, low WC was not associated with a significantly different risk compared with normal weight and low WC, except for all-cause mortality, for which risk was significantly lower. In contrast to men, women with obesity but low WHR retained significantly higher risk for all outcomes compared with normal weight and low WHR; however, the HRs were smaller compared with those with obesity and high WHR. Among individuals with obesity, the population attributable risk associated with elevated WC or WHR ranged from 13% to 49%, with the highest estimates observed for elevated WC in heart failure and atrial fibrillation.

conclusionsWC and WHR identifies misclassification of conventional BMI categories and reclassifies CVD risk across normal weight, overweight, and obesity, adding diagnostic and prognostic value.

Indexed as

Body Mass IndexCardiovascular DiseasesWaist CircumferenceWaist-Hip RatioAgedCohort StudiesFemaleHumansMaleMiddle AgedObesityPrognosisRisk Assessmentcardiovascular diseasecross-cohort collaborationobesity

Identifiers

PMID42583989
PMCPMC13470613

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