Fat Distribution and Heart Disease in Women

Obesity may predispose patients to the development of CHD⁴⁵ and substantially increases the risk of CAD mortality.⁵⁰ BMI has traditionally been used to determine obesity (BMI ≥30). However, while a clear association between BMI and atherosclerosis has been shown in men, such an association has not been shown in women.^51,52 In recent years, it has become increasingly believed that abdominal fat has a stronger association with heart disease risk in women than fat in other areas.⁵³

Waist-Hip Ratio vs BMI

It has recently been recommended that obesity be redefined by waist-hip ratio (WHR) rather than BMI.⁵⁴ In older women, WHR offers prognostic information beyond BMI and waist circumference.⁴⁷

• WHR has been shown to be a strong predictor of mortality in women⁴⁷ and has a highly significant association with myocardial infarction (MI) risk.⁵⁴
• Increasing BMI was associated with increasing MI risk, but after adjusting for WHR and other risk factors, the association vanished.⁵⁴
• The association between increasing WHR and increasing MI risk remained highly significant (P < .0001) after adjusting for BMI and other risk factors.⁵⁴

Fat Distribution and Cardiovascular Risk

• Lipid metabolism appears to be influenced by regional fat distribution.^51,55 Higher WHR has been shown to correlate with increased total and LDL cholesterol and decreased HDL cholesterol.⁵⁵
• Lower-body fat in postmenopausal women may actually be protective against cardiovascular risk, having positive effects on serum triglycerides and HDL cholesterol as well as insulin and glucose measures.⁵³