Coronary artery disease patients who have even a modest beer belly or muffin top are at higher risk for death than people whose fat collects elsewhere, according to a new study. The effect was observed even in patients with a normal BMI.
Researchers at the Mayo Clinic analyzed data from 15,923 people with coronary artery disease involved in five studies from around the world. They found that those with coronary artery disease and central obesity, measured by waist circumference and waist-to-hip ratio, have up to twice the risk of dying. That is equivalent to the risk of smoking a pack of cigarettes per day or having very high cholesterol, particularly for men.
The findings refute the obesity paradox, a puzzling finding in many studies that shows that patients with a higher BMI and chronic diseases such as coronary artery disease have better survival odds than normal-weight individuals.
“We suspected that the obesity paradox was happening because BMI is not a good measure of body fatness and gives no insight into the distribution of fat,” said Thais Coutinho, the study''s lead author and a cardiology fellow at Mayo Clinic.
“BMI is just a measure of weight in proportion to height. What seems to be more important is how the fat is distributed on the body,” she said.
“Visceral fat has been found to be more metabolically active. It produces more changes in cholesterol, blood pressure and blood sugar. However, people who have fat mostly in other locations in the body, specifically, the legs and buttocks, don''t show this increased risk,”said Francisco Lopez-Jimenez, the project''s lead investigator and director of the Cardiometabolic Program at Mayo Clinic.
The researchers said physicians should counsel coronary artery disease patients who have normal BMIs to lose weight if they have a large waist circumference or a high waist-to-hip ratio.
The findings are published in the May 10 issue of the Journal of the American College of Cardiology