In a new study, researchers found that heart attack survivors who carry excess fat around their waist are at increased risk of another heart attack.
It is the largest and most definitive ever conducted on this topic.
The research was conducted by a team at Karolinska Institute.
Previous studies have shown that abdominal obesity is an important risk factor for having a first heart attack.
But until now, the link between abdominal obesity and the risk of a subsequent heart attack or stroke was unknown.
The team says patients are typically put on a stringent medical treatment regimen after their first heart attack to prevent second events (called secondary prevention).
Secondary prevention works through reducing risk factors associated with a heart attack and strokes such as high blood sugar, lipids, and blood pressure.
It was previously unknown whether abdominal obesity is a risk factor for recurrent events among patients on secondary prevention treatments.
In the study, the team followed more than 22,000 patients after their first heart attack and examined the link between abdominal obesity (measured by waist circumference) and the risk for recurrent cardiovascular disease events.
The researchers specifically looked at events caused by clogged arteries, such as fatal and non-fatal heart attacks and stroke.
Patients were recruited from the nationwide SWEDEHEART registry and followed for a median of 3.8 years.
Most patients—78% of men and 90% of women—had abdominal obesity (waist circumference 94 cm or above for men and 80 cm or above for women).
The team found increasing belly fat was linked to fatal and non-fatal heart attacks and strokes, regardless of other risk factors (such as smoking, diabetes, hypertension, blood pressure, blood lipids and body mass index [BMI]) and secondary prevention treatments.
Waist circumference was a more important marker of recurrent events than overall obesity.
The team says the reason abdominal obesity is very common in patients with a first heart attack is that it is closely linked with conditions that accelerate the clogging of arteries through atherosclerosis.
These conditions include increased blood pressure, high blood sugar and insulin resistance (diabetes) as well as raised blood lipid levels.
The findings also suggest that there may be other negative mechanisms associated with abdominal obesity that are independent of these risk factors and remain unrecognized.
The authors recommend using waist circumference in clinical settings to identify first-time heart attack patients at increased risk of recurrent events.
One author of the study is Dr. Hanieh Mohammadi of the Karolinska Institute.
The study is published in the European Journal of Preventive Cardiology.
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