Predictive Value of Waist-to-Height Ratio Versus Body Mass Index in Cardiovascular Disease and Heart Failure: Insights from the PARAGON-HF and SELECT Trials

Background: Body Mass Index (BMI) is widely used to assess cardiovascular risk but is confounded by the "obesity paradox." Emerging metrics like the Waist-to-Height Ratio (WHtR) may offer superior prognostic accuracy by measuring central adiposity.Objective: This mini-review evaluates the predictive value of WHtR versus BMI in heart failure (HF) and cardiovascular disease (CVD), utilizing recent data from the landmark PARAGON-HF and SELECT trials.Discussion: Clinical evidence indicates that while BMI often obscures true mortality risks, WHtR aligns linearly with adverse myocardial outcomes. Visceral fat, measured by WHtR, acts as an active endocrine tissue secreting pro-inflammatory cytokines (IL-6, TNF-α) that accelerate atherogenesis and myocardial fibrosis. Data from PARAGON-HF and SELECT demonstrate that central adiposity is a more reliable predictor of HF hospitalizations and cardiovascular mortality than total body weight.Conclusion: Transitioning clinical workflows from BMI to WHtR thresholds (≥ 0.5) is essential for uncovering hidden metabolic risks and improving long-term survival in cardiovascular patients Keywords: Waist-to-Height Ratio; Obesity Paradox; Heart Failure;