Waist size, not BMI, may predict coronary artery disease better

In a new study, researchers found the location of the fat that matters most for heart health.

They found belly fat representing the greatest harm and not overall body mass index (BMI) when assessing risk for coronary artery disease (CAD).

Because CAD remains the leading cause of death worldwide, there is tremendous attention given to its risk factors.

Estrogen protects women’s cardiovascular systems before menopause, which helps explain why the incidence of CAD in premenopausal women is lower than in men.

However, as women’s estrogen levels decline during and after menopause, the incidence of CAD in postmenopausal women outpaces similarly aged men.

Obesity has long been known as a risk factor for CAD because it causes endothelial cell dysfunction, insulin resistance, and coronary atherosclerosis, among other problems.

It also is often accompanied by other risk factors, such as high blood pressure and diabetes.

In the past, it has been suggested that overall obesity (which is often defined by BMI) is a primary risk factor.

Few studies have attempted to compare the effect of overall obesity versus central obesity, which is typically described by waist circumference and/or waist-to-hip ratio.

In the new study, the team examined nearly 700 Korean women and demonstrated that the presence of CAD was much higher in women with central obesity.

No significant difference was identified based on BMI, indicating that overall obesity was not a risk factor for obstructive CAD.

These results are especially relevant for postmenopausal women because menopause causes a change in body fat distribution, especially in the abdominal area.

The team says identifying women with excess abdominal fat, even with a normal BMI, is important so that lifestyle interventions can be implemented.

One author of the study is Dr. Stephanie Faubion, NAMS medical director.

The study is published in Menopause.

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