Excess Belly Fat Linked to Increased Risk of Recurrent ASCVD

A new study from the Karolinska Institute in Sweden is shedding light on the potential association between excess belly fat and increased risk of a secondary cardiovascular event for the first time.

After examining data of more than 22,000 individuals, investigators determined increasing levels of abdominal obesity were associated with an increased risk of subsequent heart attack or stroke in patients who previously suffered from myocardial infarction(MI).

"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,” said Hanieh Mohammadi, MD, of the Department of Clinical Sciences and Education of the Karolinska Institute.

To evaluate whether an association between abdominal obesity and recurrent atherosclerotic cardiovascular (ASCVD) after myocardial infarction exists, Mohammadi and colleagues conducted an observational study of patients from the SWEDEHEART registry. From the registry, a cohort of 22,882 patients with MI as the first manifestation of ASCVD was identified for inclusion.

Investigators noted the use of univariable multivariable-adjusted Cox regression models were used to assess associations between WC and BMI with risk of recurrent ASCVD. Covariates included age, gender, smoking, diabetes, hypertension, systolic blood pressure, left ventricle ejection fraction, non-sinus rhythm ECG, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, BMI and inclusion year.

For inclusion in the study, patients in the registry needed to be between the ages of 35 and 77 years and have a waist circumference (WC) measurement during a follow-up visit. Of the 22,882 included, 16,950 were men and 5932 were women—mean WC was 101.3 cm for men and 94.1 for women.

For the purpose of analyses, participants were divided into 5 different sex-specific quintiles of WC as well as 3 BMI categories. BMI. Categories for BMI included normal weight (less than 25.0 kg/m2), overweight (between 25.0 kg/m2 and 30.0 kg/m2), and obesity (greater than 30.0 kg/m2).

Of the 16950 men, 31.6% had a WC within the World Health Organization range for increased CV risk and an additional 46.1% met the criteria for greatly increased risk. In the 5932 women included, 19.8% met the criteria for increased risk and an additional 67.9% met the criteria for greatly increased risk. Investigators note the man BMI for men was 27.4 (3.9) and 27.2 (5.0) for women.

Over a median of 3.8 years, investigators observed recurrent ASCVD events in 1231 men and 469 women. Results of the univariate analysis revealed patients in the fifth quintile of WC had a significantly increased risk of event compared to patients in the first quintile (HR 1.22, 95% CI 1.07—1.39). In the multivariable analysis, both the fourth and fifth quintiles were associated with significantly increased risk when compared to the first quintile(HR 1.21, CI 1.03–1.43 and HR 1.25, CI 1.04–1.50, respectively).

Investigators also noted increases in average BMI, systolic blood pressure, prevalence of hypertension, non-sinus rhythm ECG, and diabetes mellitus were all associated with increased WC in both men and women.

Mohammadi and colleagues suggest—based on the results of their study—clinicians and care providers should possibly consider using WC to aid in identifying patients at an increased risk of a secondary ASCVD event after MI.

This study, titled “Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction,” was published in the European Journal of Preventive Cardiology.