NEW YORK (Reuters Health) – As a measure of adiposity, waist-to-height ratio appears to be the best predictor of cardiovascular disease (CVD), researchers at Harvard Medical School have found. Nevertheless, the small differences in cardiovascular risk between individual anthropometric measures observed in their prospective data analysis are not likely to be clinically meaningful.

“Our findings emphasize that higher levels of adiposity, however measured, confer increased risk of CVD,” Dr. Tobias Kurth and colleagues report in the August 19 Journal of the American College of Cardiology.

Although body mass index (BMI) is the standard gauge of adiposity, there is concern that persons with “normal” BMI may still be at higher risk because of central fat distribution.

Dr. Kurth’s group compared the ability of BMI, waist-to-height ratio, waist-to-hip ratio and waist circumference to predict incident major CVD using data from the Physicians’ Health Study and Women’s Health Study. Included were 16,332 men (mean age 61 years) and 32,700 women (mean age 61 years). During median follow-up of 14.2 years in the male cohort and 5.5 years in the female cohort, close to 2000 major CVD incidents occurred.

“The waist-to-height ratio most consistently showed the strongest associations and statistically best model fit,” the authors report. However, both overall and central adiposity confer risk, and they support BMI as “the most clinically practical measure of adiposity.”

Dr. Sheldon E. Litwin, at the University of the Utah School of Medicine in Salt Lake City, agrees with this viewpoint, stating in an editorial that “there is no ‘good’ fat – the fat cell is the enemy.”

“As medical professionals and scientists, let us speak with a united, unequivocal voice when we talk to our patients about obesity,” he advises. Since BMI is the simplest and most widely accepted measure of obesity, “we serve our patients and our communities best by singularly adopting this metric.”

J Am Coll Cardiol 2008;52:605-618.