A new study provides further evidence that higher waist size and waist-to-hip ratio signal a greater risk for myocardial infarction (MI) than general obesity, especially in women.
Compared with body mass index (BMI), waist-to-hip ratio was an 18% stronger predictor of MI in women and a 6% stronger predictor of MI in men.
"The general message is that excess weight matters but that women who indeed have an apple shape might be at an even greater risk. So it's about increased awareness not only among the women themselves but also among physicians," study author, Sanne AE Peters, PhD, from the George Institute for Global Health, University of Oxford, United Kingdom, said in an interview.
"One might argue that we need more intensive screening, particularly among women with an apple shape, to try and really identify their increased risk of heart disease and, for example, to start interventions whether they're lifestyle interventions to lose weight or to start other preventive strategies," she added.
Peters noted that previous studies have indeed shown that central adiposity might be a stronger risk factor than overall obesity, but there have been studies that have shown the opposite — that it actually does not matter where adiposity is measured.
"The critical new thing in our work is that we've looked at sex differences between both central and overall adiposity and the risk of heart disease and what we found is that central adiposity is actually an even stronger risk factor for heart disease in women than in men," she said.
The study, published online February 28 in the Journal of the American Heart Association, involved 265,988 female and 213,622 male participants aged 40 to 69 years (mean, 56 years) in the prospective UK Biobank study between 2006 and 2010. Exclusion criteria included a history of cardiovascular disease or BMI less than 15 kg/m2 or greater than 60 kg/m2.
Participants completed questionnaires on their lifestyle, environment, and medical history and had blood, urine, and saliva collected. Physical measurements included weight, height, hip circumference, waist circumference, and waist-to-hip ratio.
At study entry, the mean waist circumference, waist-to-hip ratio, and waist-to-height ratio, respectively, were 85 cm (33.46 inches), 0.82, and 0.52 in women and 97 cm (38.18 inches), 0.93, and 0.55 in men.
During a mean follow-up of 7.1 years, there were 5710 MIs, of which 28% were in women.
In both sexes, there was an approximate log-linear relationship between measures of general and central adiposity and the risk for incident MI.