Big Bellies Spell 42-44% Bigger Heart Risk

IF YOUR BELLY enters the room before the rest of you, a new study finds, you may be headed for the cardiac ward. As researchers continue to search for more accurate predictors of a person's potential heart-disease risk than the familiar body-mass index (BMI), Carlos Iribarren, MD, of Kaiser Permanente of Northern California and colleagues set out to see whether obesity in the abdomen matters more than overall obesity. They looked for an association between risk of developing heart disease and a measurement called sagittal abdominal diameter (SAD). Your SAD represents the distance from your back to your upper abdomen, midway between the top of the pelvis and the bottom of the ribs; researchers measured SAD when subjects were standing.

The researchers studied 101,765 men and women patients at Kaiser Permanente who'd had checkups between 1965 and 1970. The patients were then followed for an average of 12 years. The subjects were divided into four groups, or quartiles, based on SAD, and their heart-disease rates adjusted for age, race, BMI, educational level, smoking, alcohol consumption and women's use of hormone replacement therapy.

The findings, published in the American Journal of Epidemiology, showed that men with the biggest bellies--those in the upper quartile of sagittal abdominal diameter--had a 42% greater risk of developing coronary heart disease than those in the trimmest group. Among women, the quartile with the biggest SAD measurements was at 44% greater risk than the group with the smallest SAD scores.

The authors concluded, "Standing sagittal abdominal diameter was a strong predictor of coronary heart disease independently of BMI, and added incremental coronary heart disease prediction at each level of BMI" when used in conjunction with BMI.

Previous studies have similarly suggested that waist-to-hip ratio is a better predictor of heart risk than BMI (see the November 2006 Healthletter).

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