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Contact: amurphy@acc.org;
202-375-6476
August 13, 2007
Pot bellies linked to early signs of
cardiovascular disease
Even a moderate bulge at the waist increases the risk
of calcium deposits in the arteries
Most of us rely on the bathroom scale to tell
us when middle-aged spread is getting out of hand. It might
be better to keep a tape measure at the ready. New research
shows that adding several inches to the waist—even if
body weight still falls within a normal range—markedly
increases the risk of unhealthy plaque build-up in the arteries
of the heart and the rest of the body.
The research, conducted at the University of Texas Southwestern
Medical Center in Dallas, appears in the August 21, 2007,
issue of the Journal of the American College of Cardiology
(JACC).
According to the study, the relationship of the waist measurement
to the hip measurement was much more closely tied to early,
hidden signs of heart disease than other common measures of
obesity, such as body mass index (BMI) or the waist circumference
alone. In other words, we may obsess about unsightly cellulite
on our hips, but it’s the pot belly we ought to worry
about.
“In our thirties and forties, we often gain three to
four inches in the midsection,” said James A. de Lemos,
M.D., F.A.C.C., a professor of medicine and director of the
Coronary Care Unit at the University of Texas Southwestern
Medical Center. “It’s a day-to-day, meal-to-meal
battle, but it’s worth fighting. Even a small pot belly
puts us at higher risk when compared to a flat tummy.”
For the study, Dr. de Lemos and his colleagues examined data
from the ongoing Dallas Heart Study, which is evaluating risk
factors for heart disease in a large, multiethnic, urban population
with a median age of 45. The new substudy focused on a group
of 2,744 participants who had noninvasive imaging tests to
look for early signs of plaque build-up in the arteries, which
signals an increased risk of developing cardiovascular disease
later in life.
Electron-beam computed tomography (EBCT) was used to identify
calcium deposits in the arteries of the heart. These deposits
indicate the onset of atherosclerosis, or so-called hardening
of the arteries, and can be detected years before a person
experiences chest pain or has a heart attack. Magnetic resonance
imaging (MRI) was used to look for early signs of atherosclerosis
in the walls of the aorta.
Researchers then examined the relationship between body shape
and early signs of arterial disease. They found that the likelihood
of calcium being found in the arteries of the heart grew in
direct proportion to increases in the waist-to-hip ratio (WHR).
In addition, when they divided the WHR into five groups from
smallest to largest, they found that people with the largest
WHR were nearly twice as likely to have calcium deposits in
their coronary arteries as those with the smallest WHR. The
likelihood of atherosclerotic plaque in the aorta was three
times as high in those with the largest WHR as compared to
the smallest.
The relationship between WHR and arterial plaque remained
strong even after other risk factors, such as blood pressure,
diabetes, age, smoking and high cholesterol levels were taken
into account.
“Middle-aged spread is not healthy,” Dr. de Lemos
said. “We don’t have to clean our plates. It’s
better to throw food out than add it to our waists.”
Using the waist-to-hip measurement to gauge cardiovascular
risk has certain clinical advantages, said Raimund Erbel,
M.D., West German Heart Center Essen. “The WHR can be
easily measured, taking only a few moments and giving more
precise information on the presence of coronary artery calcium
than BMI or waist circumference,” Dr. Erbel said. “In
addition, although BMI is used more often, it does not identify
patients with central obesity, which seems to be related to
the metabolic syndrome, insulin resistance and abnormal cholesterol
levels. However, most important is that other measures of
obesity did not discriminate beyond traditional risk factors,
whereas WHR did.”
“The results are most astonishing and may be influenced
by the age distribution of the study,” Dr. Erbel added.
“During life, the likelihood of coronary artery calcium
increases more in men than in women. It may be that in an
older population, in which the duration of risk factor exposure
is longer and the likelihood of coronary artery calcium is
higher, the association between obesity—as measured
by BMI and waist circumference—and signs of early atherosclerosis
is stronger.”
This study was funded by the Donald W. Reynolds Foundation.
The American College of Cardiology is leading the way to
optimal cardiovascular care and disease prevention. The College
is a 34,000-member nonprofit medical society and bestows the
credential Fellow of the American College of Cardiology upon
physicians who meet its stringent qualifications. The College
is a leader in the formulation of health policy, standards
and guidelines, and is a staunch supporter of cardiovascular
research. The ACC provides professional education and operates
national registries for the measurement and improvement of
quality care. More information about the association is available
online at www.acc.org .
The American College of Cardiology (ACC) provides these
news reports of clinical studies published in the Journal
of the American College of Cardiology as a service to physicians,
the media, the public and other interested parties. However,
statements or opinions expressed in these reports reflect
the view of the author(s) and do not represent official policy
of the ACC unless stated so.
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