Background: Heart failure with preserved ejection fraction (HFpEF) is a common obesity-related complication that often develops before symptoms. Body mass index (BMI) poorly captures visceral adiposity, the metabolically active fat linked to cardiometabolic dysfunction, myocardial remodeling, and diastolic dysfunction. Waist circumference (WC) is a simple, inexpensive surrogate but remains underused.
Objectives: This review summarizes evidence linking central adiposity to left ventricular diastolic dysfunction (LVDD) and HFpEF and proposes a practical framework for integrating WC into routine vitals to enable earlier risk stratification and prevention.
Evidence summary: The Baltimore Longitudinal Study of Aging (BLSA) showed that WC predicts diastolic dysfunction independent of BMI and traditional risk factors. Epidemiologic, imaging, and mechanistic studies support visceral and ectopic adiposity as drivers of inflammation, fibrosis, endothelial dysfunction, impaired relaxation, and cardiac remodeling. Trials of glucagon-like peptide-1 (GLP-1) receptor agonists and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists suggest that reducing visceral adiposity improves cardiometabolic and functional outcomes in obesity-related HFpEF.
Translational framework: We propose WC as a cardiometabolic vital sign and introduce the waist-to-heart translational framework, integrating routine WC measurement with cardiometabolic assessment, symptom review, HFpEF risk scores, biomarkers, and targeted echocardiography to identify HFpEF in primary care clinics.
Conclusion: Central adiposity is a stronger determinant of obesity-related cardiac dysfunction than BMI alone and is an actionable prevention target. Routine WC measurement offers a scalable, low-cost strategy to improve risk stratification. Prospective validation is needed to assess clinical impact and implementation.
doi: 10.17756/jocd.2026-059
Citation: Moni M. 2026. Waist Circumference as a Cardiometabolic Vital Sign: A Translational Framework for Early Detection and Prevention of Heart Failure with Preserved Ejection Fraction in Primary Care. J Obes Chronic Dis 10(1): 12-17.
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