Background <p>Anthropometric measures can be obtained easily and quickly and have the potential for prognostic stratification in the context of cardiovascular disease (CVD). This study evaluates the prognostic value of the waist-to-BMI ratio, a body shape index (ABSI), body roundness index (BRI), waist circumference (WC), and body mass index (BMI) for CVD mortality prediction in the general population, compared with the Framingham risk score (FRS).</p> Methods <p>Data of participants from the United States Third National Health and Nutrition Examination Survey (NHANES III) (1988 to 1994), aged 40–79 years with complete data were extracted and analyzed. Cox regression, receiver operating characteristic (ROC) curve analysis, and the C-index were used to determine the predictive value of the anthropometric parameters for CVD mortality, with follow-up through the end of 2019 via the National Center for Health Statistics (NCHS) Linked Mortality File.</p> Results <p>After applying inclusion and exclusion criteria, 6,746 individuals (mean age 57.6 years) were analyzed. Cox regression indicated significant associations between BMI, WC, waist-to-BMI ratio, BRI, ABSI, and increased CVD mortality risk (adjusted hazard ratios [aHR] = 1.11, 1.19, 1.07, 1.12, and 1.13, respectively). ROC analysis revealed that FRS had the best performance for predicting 10-year CVD mortality (AUC = 0.7252), followed by ABSI (0.6407) and waist-to-BMI ratio (0.6120). Time-dependent AUC analyses confirmed FRS had the highest C-index (0.7004), followed by ABSI (0.6358) and waist-to-BMI ratio (0.5807).</p> Conclusions <p>Our study suggests that, among the anthropometric measures studied, ABSI and waist-to-BMI ratio may offer predictive capability for CVD mortality in the general US population. The simplicity of measuring and calculating the waist-to-BMI ratio enhances its practicality, making it a potentially useful tool, particularly when other clinical factors are not available.</p> Clinical trial number <p>Not applicable.</p>