Both men and women with excess body fat have an increased risk of heart attack, but the risk is higher in people who have an “apple-shaped” rather than a “pear-shaped” body, according to a recent study published in the Journal of the American Heart Association

That finding was especially true for women, for whom having an apple-shaped body was three times stronger at predicting the risk of heart attack than it was for apple-shaped men. 

The study’s findings suggest, say its authors, that the distribution of body fat — specifically extra fat around the waist — may be a better indicator of the risk of heart attack than body mass index (BMI), particularly in women.

“Apple shape” is a popular term for something called central obesity — having a high waist-to-hip ratio, or a waist that is large compared to the hips. Previous research has associated fat around the waist with a higher risk of several chronic medical conditions, including heart disease and type 2 diabetes — even when BMI is within the recommended range.

The current study looked at whether body-fat distribution is linked to having a heart attack — and how that link might differ in women and men. 

Study details

For the study, a team of researchers from Great Britain, Australia and the United States analyzed data collected from 479,610 adults aged 40 to 69 who were participating in UK Biobank, an ongoing British health study.

None of the participants had a history of heart disease when they started the study. The mean BMI was 27 for the women and 28 for the men. The participants were followed for an average of seven years, during which 5,710 had heart attacks. Of those, 28 percent were women.

The study found, not unsurprisingly, that having a higher BMI was linked to an increased risk of heart attack. The increased risk was greater among the men.

When it came to where the weight was distributed on the body, however, women with a higher-than-average waist size had a greater risk of heart attack than men with a higher-than-average waist size. Specifically, waist-to-hip ratio was an 18 percent stronger predictor than BMI of heart attack in women and a 6 percent stronger predictor in men.

The study also found that having a high waist-to-hip ratio was more strongly associated with heart attack risk than any other type of body fat measurement — especially in women.

Those findings held even when the researchers adjusted for several confounding factors, such as age, socioeconomic status and smoking history.

Limitations and implications

This study was observational, which means it can show only a correlation, not a direct causal link, between higher waist-to-hip ratios and an increased risk of heart attack. Other factors not adjusted for by the researchers — such as alcohol use and a sedentary lifestyle — may also explain the results.

In addition, the participants in the study were mainly white, so the findings may not be applicable to other populations. 

Still, the results “support the notion that having proportionally more fat around the abdomen (a characteristic of the apple-shaped body) appears to be more hazardous than more visceral fat which is generally stored around the hips (i.e., the pear shape),” said Sanne Peters, the study’s lead author and a research fellow in epidemiology at the George Institute for Global Health at the University of Oxford, in a released statement.

Take-home message

According to U.S. health experts, the risk for heart disease and type 2 diabetes increases for women when their waist size is greater than 35 inches and for men when it’s greater than 40 inches.

Unfortunately, however, there’s no way you can reduce your waist size without shedding overall pounds.

“The general message [of this study] is that excess weight matters but that women who indeed have an apple shape might be at an even greater risk. So it’s about increased awareness not only among the women themselves but also among physicians,” Peters, told Medscape reporter Patrice Wending.

“One might argue that we need more intensive screening, particularly among women with an apple shape, to try and really identify their increased risk of heart disease and, for example, to start interventions whether they’re lifestyle interventions to lose weight or to start other preventive strategies,” she added.

FMI: You can read the study on the website for the Journal of the American Heart Association.




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