(HealthDay News) — Individuals with a high waist-to-hip ratio (WHR) and normal body mass index (BMI) have the worst cardiovascular mortality, according to a study presented at the annual European Society of Cardiology Congress, held from Aug. 25 to 29 in Munich.

Karine Sahakyan, M.D., Ph.D., from the Mayo Clinic in Rochester, Minn., and colleagues examined the impact of central obesity on mortality in individuals with normal BMI. Data were analyzed for 12,785 participants from the National Health and Nutrition Examination Survey III (mean age 44 years; 47.4 percent men) who were stratified according to BMI (normal, overweight, and obese) and WHR (≥0.85 m versus <0.85 m in women and ≥0.90 m versus <0.90 m in men).

During a median follow-up of 14.3 years, the researchers identified 1,138 cardiovascular deaths. The worst cardiovascular mortality was seen for individuals with normal BMI/high WHR (unadjusted hazard ratio [HR], 3.79; adjusted HR, 2.75 [compared to those with a normal BMI/normal WHR]). Individuals with normal BMI/high WHR had significantly higher total and cardiovascular mortality compared with those individuals who were classified as obese based on their BMI (HR, 1.36 and 1.20, respectively). The associations persisted after exclusion of individuals with history of heart failure, coronary artery disease, and stroke at baseline.

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“We knew from previous research that central obesity is bad, but what is new in this research is that the distribution of the fat is very important even in people with a normal weight,” a coauthor said in a statement. “This group has the highest death rate, even higher than those who are considered obese based on body mass index. From a public health perspective, this is a significant finding.”

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