Weight-Adjusted Waist Index Predicts Cardiovascular Risk in Patients with T2D

The weight-adjusted waist circumference index is closely associated with future cardiovascular outcomes and total mortality in patients with type 2 diabetes mellitus (T2DM), according to a recent retrospective cohort analysis of data from the ACCORD trial.1

“This retrospective cohort study is designed to investigate the correlation between [the weight-adjusted waist index] and cardiovascular outcomes within the participants of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) cohort, aiming to generate new insights that may support clinical practices and provide valuable references for risk assessment and tailored management strategies for adverse cardiovascular outcomes in T2DM patients,” Maojun Liu, MD, department of cardiovascular medicine, the Second Xiangya Hospital, Central South University, Hunan, China, and colleagues wrote.1

ACCORD was a randomized, multicenter phase 3 trial conducted across 77 locations. The trial consisted of 3 arms, investigating whether lowering blood glucose, blood pressure, or LDL cholesterol levels past current guideline-recommended levels reduced cardiovascular disease risk. All 3 arms received intensive control, and each arm was accompanied by an active comparator cohort receiving standard control.1,2

Investigators included patients with T2DM, determined by a fasting plasma glucose level >126 mg/dl or a 2-hour postload value in the oral glucose tolerance test of >200 mg/dl, as well as a history of cardiovascular disease in patients aged ≥40 years. To be included, patients ≥55 years were required to be at high risk for experiencing a cardiovascular event due to existing cardiovascular disease, subclinical disease, or ≥2 risk factors. Primary outcome measures for ACCORD included first occurrence of major cardiovascular events, including nonfatal heart attack, nonfatal stroke, or cardiovascular death, in each arm.2

Ultimately, 10,251 patients were enrolled in ACCORD, with a mean age of 62.2 years and a median HbA1c of 8.1%. The trial ultimately indicated no correlation between any of the 3 arms and reduced mortality due to cardiovascular disease events.3

In this retrospective cohort analysis, Liu and colleagues collected baseline weight-adjusted waist index data from 10,148 patients from ACCORD, omitting 103 due to missing data. The primary endpoint for the study was the occurrences of major adverse cardiovascular events (MACEs) – specifically nonfatal myocardial infarctions, nonfatal strokes, and death from cardiovascular causes. The secondary endpoint examined composites of the above outcomes.1

Using a Cox proportional hazards regression model, investigators found a correlation between higher weight-adjusted waist index quartiles and increased risk of MACEs, congestive heart failure, and total mortality. A median follow-up of 8.82 years revealed that 1803 patients (17.77%) suffered MACE events. Additionally, 1927 total deaths and 690 congestive heart failure cases occurred during this follow-up period. These incidence rates were substantially increased in the higher quartiles.1

Ultimately, investigators established that an increase of per 1 standard deviations (SD) in weight-adjusted waist index corresponded with a 7% increased risk of MACEs (HR, 1.07; 95% CI, 1.02-1.13), a 20% greater risk of congestive heart failure (HR, 1.2; 95% CI, 1.1-1.3), and an 11% increase in total mortality (HR, 1.11; 95% CI, 1.06-1.17). Subgroup analyses also demonstrated that the weight-adjusted waist index more accurately predicted congestive heart failure risk in patients whose diabetes duration was <10 years.1

“Our research underscores the utility of the novel obesity metric, [the weight-adjusted waist index], as an effective predictor of adverse cardiovascular outcomes and overall mortality in T2DM patients,” Liu and colleagues wrote. “Maintaining [the weight-adjusted waist index] within a defined healthy range is associated with significant improvements in cardiovascular health and reductions in mortality. These observations highlight the importance of diligent monitoring of [weight-adjusted waist index] for clinical management and prevention, particularly in diabetic patients.”1

References

1. Liu M, Pei J, Zeng C, Xin Y, Tang P, Hu X. Associations and predictive value of weight-adjusted waist index for cardiovascular outcomes in type 2 diabetes: evidence from the ACCORD study. Nutr J. 2025;24(1):184. Published 2025 Dec 17. doi:10.1186/s12937-025-01251-0

2. National Heart, Lung, and Blood Institute (NHLBI). Action to Control Cardiovascular Risk in Diabetes (ACCORD) (ACCORD). ClinicalTrials.gov Identifier: NCT00000620. Updated November 22, 2016. Accessed January 2, 2026. https://clinicaltrials.gov/study/NCT00000620

3. The Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. New England Journal of Medicine. 2008;358(24):2545-2559. doi:10.1056/nejmoa0802743