This study involved over 22,000 patients who were followed for a median of 3.8 years that were recruited from the SWEDEHEART national registry. 78% of the men and 90% of the women had abdominal obesity. Patients were followed after their first heart attack to investigate the relationship between waist circumference and the risk of recurrent cardiovascular disease events; specifically looking at events caused by clogged arteries such as fatal and non-fatal heart attack and stroke.
“Patients are typically put on a stringent medical treatment regimen after their first attack to prevent second events (called secondary prevention). Secondary prevention works through reducing risk factors associated with heart attack and stroke 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,” said author Dr. Hanieh Mohammadi of the Karolinska Institute.
Increasing belly fat was found to be independently associated with fatal and non-fatal strokes and heart attacks regardless of other risk factors such as BMI, blood lipids, smoking, high blood pressure, and diabetes; waist circumference was a more important marker of recurrent events than overall obesity.
“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,” explains Dr. Mohammadi. “Our results, however, suggest that there may be other negative mechanisms associated with abdominal obesity that are independent of these risk factors and remain unrecognized,” she added. “In our study, patients with increasing levels of abdominal obesity still had a raised risk for recurrent events despite being on therapies that lower traditional risk factors connected with abdominal obesity such as anti-hypertensives, diabetes medication and lipid lowering drugs.”
This was the first study to analyze men and women both separately and together, which allowed the researchers to find relationships between waist circumference and recurrent events were stronger in men, and the mid-range waist circumference rather than the lowest was the least risky for women. Several hypotheses could explain the differences between the genders such as there being three times as many men in the study group; previous studies suggest that abdominal obesity can be more directly associated with visceral fat in men; and women are thought to have more subcutaneous fat than men.
“Abdominal obesity not only increases your risk for a first heart attack or stroke, but also the risk for recurrent events after the first misfortune. Maintaining a healthy waist circumference is important for preventing future heart attacks and strokes regardless of how many drugs you may be taking or how healthy your blood tests are. Abdominal obesity can be tackled by eating a healthy and balanced diet and regular physical activity,” according to the researchers who also noted that additional studies are required.
