Weight-Adjusted Waist Index Can Predict CVD Risk in Cardiovascular Kidney Metabolic Syndrome

New research reports the weight-adjusted waist index (WWI) as the most significant obesity index for predicting cardiovascular disease (CVD) in patients with cardiovascular-kidney-metabolic (CKM) syndrome.1

Findings suggest clinicians can use the WWI index as an improved, simple anthropometric indicator for initial risk stratification in individuals with CKM stages 0-3, offering better predictive value than body mass index (BMI) and waist circumference (WC).1

“WWI standardizes WC by total body weight, penalizing individuals with disproportionately large waists relative to their body mass, thereby providing a more accurate reflection of central adiposity and fat distribution,” wrote study investigator Ming Guo, PhD, deputy chief physician at Xiyuan Hospital, and colleagues. “This characteristic enables WWI to serve as a practical proxy for an unfavorable body composition phenotype, defined by excessive visceral adiposity in conjunction with reduced muscle mass.”1

Nearly 90% of US adults meet the criteria for ≥ stage 1 CKM syndrome. Management of stages 0–3 typically targets excess adiposity to reduce the risk of future cardiovascular events, including CVD. Early interventions generally emphasize lifestyle and weight-based strategies, whereas pharmacological treatment of metabolic syndrome components is usually reserved for later stages. Recognition of disease predictors may support improved patient outcomes.2

Investigators conducted a prospective cohort study using data from UK Biobank. They assessed the association between 9 obesity-related indices, WWI, cardiometabolic index, waist-to-height ratio, conicity index, relative fat mass, visceral adiposity index, BMI, WC, and lipid accumulation product, with the risk of incident CVD.1

The study enrolled 13,064 participants with stage 0-3 CKM syndrome. In a 15.4-year median follow-up period, 19.42% of individuals developed CVD (n = 2537). These individuals demonstrated significantly increased values of age, weight, blood pressure, fasting blood glucose, glycated hemoglobin A1c, creatinine, triglycerides, and all 9 obesity-based indices.1

Upon multivariable Cox proportional hazards analyses, investigators noted an increased risk of CVD linked to WWI, cardiometabolic index, waist-to-height ratio, conicity index, relative fat mass, visceral adiposity index , and BMI. WWI showed the strongest association (Hazard Ratio [HR], 1.33; 95% Confidence Interval [CI], 1.06–1.59). CMI was also significantly correlated with CVD risk (HR, 1.27; 95% CI, 1.08–1.51).1

Investigators identified nonlinear thresholds at cardiometabolic index (1.63), waist-to-height ratio (0.49), visceral adiposity index (0.65), and BMI (24.88). ROC analysis demonstrated a significant discriminatory power exhibited by WWI for predicting CVD. Subgroup analyses further showed WWI was associated with increased CVD risk in participants <60 years of age and in those with diabetes, hypercholesterolemia, or metabolic syndrome (all P <.05).1

“Among various obesity indices, WWI showed the strongest association with incident CVD among individuals with CKM syndrome stages 0–3 and may serve as a superior simple anthropometric indicator for initial risk stratification compared with traditional measures,” concluded investigators.1

References

1. Wang T, Zhang L, Chen P, Chen C, Xu L, Guo M. Weight-adjusted waist index outperforms other obesity indices for cardiovascular disease prediction in cardiovascular-kidney-metabolic syndrome: insights from UK biobank. BMC Public Health. Published online December 7, 2025. doi:https://doi.org/10.1186/s12889-025-25830-2

2. An overview of cardiovascular-kidney-metabolic syndrome. The American Journal of Managed Care. 2024;30(Suppl 10):S181-S188. doi:https://doi.org/10.37765/ajmc.2024.89670