Cardiovascular Risk Associated With General and Abdominal Obesity in Young Adults Without Traditional Risk Factors: A Korean Nationwide Cohort Study

Q: What are the key findings of this study?

Elevated waist-to-height ratio in young adults with normal body mass index was associated with a significantly increased risk of the primary composite cardiovascular outcome (aHR 1.171).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Young adults without traditional cardiometabolic risk factors (n=1743968). Intervention: Elevated waist-to-height ratio (≥0.5) with normal body mass index vs. Normal waist-to-height ratio (<0.5) with normal body mass index. Primary outcome: Composite of myocardial infarction, stroke, and cardiovascular death (aHR 1.171, 95% CI 1.118-1.226).

Q: What does this research mean for the field?

Elevated waist-to-height ratio is associated with a significantly increased risk of composite cardiovascular events and myocardial infarction among young adults with normal body mass index. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jeen Hwa Lee; Mina Kim; Hoseob Kim; Yeon Jung Lee; Myung Soo Park; Sook Jin Lee; Seongwoo Han; Dae Young Cheon

doi:10.12997/jla.2026.15.3.544

January 1, 2026Journal of Lipid and AtherosclerosisOpen Access

Cardiovascular Risk Associated With General and Abdominal Obesity in Young Adults Without Traditional Risk Factors: A Korean Nationwide Cohort Study

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Key result

Elevated waist-to-height ratio in normal-BMI young adults is linked to ~17% higher cardiovascular risk.

aHR 1.171
95% CI 1.118-1.226
n=1,743,968

Figures

Why the study?

BMI does not adequately characterize central adiposity, and waist-to-height ratio may detect cardiovascular risk not captured by BMI in young adults.

Does an elevated waist-to-height ratio increase cardiovascular risk in young adults with a normal body mass index?

Key Points

To examine whether waist-to-height ratio provides prognostic information beyond body mass index for cardiovascular risk stratification in young adults without traditional cardiometabolic risk factors.
Nationwide cohort study of 1,743,968 participants aged 30–39 years without previous stroke, myocardial infarction, hypertension, diabetes mellitus, or dyslipidemia who underwent health screening in Korea in 2009.
Participants were categorized into four groups based on body mass index and waist-to-height ratio (elevated threshold ≥0.5) and followed for a median of 14.2 years (14.21 years).
Multivariable Cox proportional hazards models were used to assess the primary composite endpoint of myocardial infarction, stroke, and cardiovascular death.
During follow-up, 37,120 participants (2.12%) experienced the composite primary outcome.
Participants with normal BMI but elevated WHtR (Group 3) showed an increased risk of the composite outcome (aHR, 1.171; 95% CI, 1.118–1.226) and myocardial infarction (aHR, 1.163; 95% CI, 1.097–1.233) compared with those having normal BMI and normal WHtR (Group 1).
Participants with elevated BMI but normal WHtR (Group 2) showed a higher stroke risk (aHR, 1.307; 95% CI, 1.240–1.379) than Group 3 (aHR, 1.203; 95% CI, 1.114–1.298), whereas cardiovascular death was significantly increased only when both BMI and WHtR were elevated (Group 4: aHR, 1.289; 95% CI, 1.172–1.417).

Study Design

Type

Cohort (n=1,743,968)

Structured PICO

Does an elevated waist-to-height ratio increase cardiovascular risk in young adults with a normal body mass index?

P

Population

1,743,968 young Korean adults (aged 30-39, 27.7% female) without traditional cardiometabolic risk factors, followed for a median of 14.2 years.

E

Exposure

Elevated waist-to-height ratio (WHtR ≥0.5) with normal BMI (<25 kg/m2)

C

Comparator

Normal waist-to-height ratio (WHtR <0.5) with normal BMI (<25 kg/m2)

O

Outcome

Composite of stroke, myocardial infarction, and cardiovascular deathcomposite

Main Result

Hazard Ratio: 1.171 (95% CI 1.118–1.226)

Absolute Event Rate: 2.32% vs 1.74%

Elevated waist-to-height ratio identifies young adults with normal BMI who are at increased cardiovascular risk, highlighting the potential utility of measuring central adiposity in this early low-risk demographic.

Limitations

Findings may not fully represent all Korean individuals in their 30s
Observational design precludes establishing causality and residual confounding by unmeasured variables cannot be excluded
Anthropometric measures obtained at a single baseline without tracking changes over time
Low absolute event rates due to low-risk young population may reduce power
BMI and WHtR are indirect indices and do not directly quantify visceral or ectopic fat
Findings limited to Korean adults aged 30-39
Cannot establish causal relationships
Residual confounding by unmeasured variables
Single baseline measurement without assessing changes over time
Relatively low absolute event rates
No imaging-based assessments to directly quantify fat

Implication

Elevated WHtR signals higher CV risk in normal-BMI young adults; hypothesis-generating and should not yet change risk stratification.

Abstract

Objective: Body mass index (BMI) is widely used to classify obesity but does not adequately characterize central adiposity. Waist-to-height ratio (WHtR) is a simple anthropometric marker of central obesity that may detect cardiovascular risk not captured by BMI. This study examined whether WHtR provides prognostic information beyond BMI for cardiovascular risk stratification in young adults. Methods: and WHtR ≥0.5. The primary endpoint was a composite of myocardial infarction (MI), stroke, and cardiovascular death. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 14.2 years, 37,120 participants (2.12%) experienced the composite outcome. After multivariable adjustment, participants with normal BMI but elevated WHtR (Group 3) had an increased risk compared with Group 1 (aHR, 1.171; 95% CI, 1.118-1.226), with a slightly higher point estimate than Group 2. A similar pattern was observed for MI, whereas stroke risk was more strongly associated with elevated BMI. Conclusion: Elevated WHtR was associated with increased risk of MI and the composite outcome among young adults with normal BMI. WHtR may provide information complementary to BMI for early cardiovascular risk stratification.

Discussion

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Cite This Study

Lee et al. (2026) conducted a cohort in Young adults without traditional cardiometabolic risk factors (n=1,743,968). Elevated waist-to-height ratio (≥0.5) with normal body mass index vs. Normal waist-to-height ratio (<0.5) with normal body mass index was evaluated on Composite of myocardial infarction, stroke, and cardiovascular death (aHR 1.171, 95% CI 1.118-1.226). Elevated waist-to-height ratio in young adults with normal body mass index was associated with a significantly increased risk of the primary composite cardiovascular outcome (aHR 1.171).

synapsesocial.com/papers/6ad0fd403afa093ea9ad02aa https://doi.org/10.12997/jla.2026.15.3.544

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Cardiovascular Risk Associated With General and Abdominal Obesity in Young Adults Without Traditional Risk Factors: A Korean Nationwide Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cardiovascular Risk Associated With General and Abdominal Obesity in Young Adults Without Traditional Risk Factors: A Korean Nationwide Cohort Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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