People with coronary artery disease who have even modest belly fat are at higher risk for death than people whose fat collects elsewhere, said a study.

The effect was observed even in patients with a normal Body Mass Index (BMI), according to the findings of an analysis by Mayo Clinic, a not-for-profit medical practice and medical research group.

Researchers analysed 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 study said.

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, MD, 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.”

Francisco Lopez-Jimenez, MD, the project’s lead investigator and director of the cardiometabolic programme at Mayo Clinic, 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.”

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.

“All it takes is a tape measure and one minute of a physician’s time to measure the perimeter of a patient’s waist and hip,” said Dr Coutinho.

The research studied people from the US, Denmark, France and Korea. The inclusion of different ethnic groups makes the study more applicable to the real world, Dr Coutinho added. - TradeArabia News Service