University of Virginia Health System

Heart Risk Linked to Pot Belly

Banish the belly, not just the pounds: That is the heart-healthy advice from a new study published in the Journal of the American College of Cardiology that finds "pot" bellies may be a significant indicator of future heart disease.

"Ten to 15 years down the road, this can lead to major cardiac problems, such as a heart attack," he says.

According to the American Heart Association, more than 870,000 Americans die from heart disease each year, making it the leading killer of both men and women.

Cardiovascular disease has long been associated with obesity, and approximately one-third of American adults are considered clinically obese, the researchers note.

Large Belly More Risk than Other Factors

But are some forms of overweight worse than others?

The research team led by de Lemos compared various ways of measuring obesity to detect signs of heart disease. They looked specifically at atherosclerosis, in which blood vessel walls become thick and stiff. This effect on the blood vessel walls can be caused by a buildup of calcium and plaque, which is composed of cholesterol and triglyceride fats.

The researchers focused on data collected between 2000 and 2002 on more than 2,700 men and women between the ages of 30 and 65, who were participating in the larger, multi-ethnic Dallas Heart Study.

Blood and urine samples were taken from all the participants following completion of a general health survey.

A subsequent clinical exam calculated both weight and body mass index (BMI) - a common obesity measurement based on weight-to-height ratios - as well as waist and hip circumference.

All the men and women then underwent noninvasive imaging tests, including magnetic resonance imaging (MRI) to assess atherosclerosis or electron beam computed tomography (EBCT) that specifically looked at arterial calcium deposits in the heart. EBCT is also called ultrafast CT.

Such calcium deposits, de Lemos and his colleagues note, collect years before the onset of chest pains or a heart attack.

Detectable coronary artery calcium was found in just more than 20 percent of the men and women tested. Almost 40 percent of the people who underwent an MRI were found to have detectable aortic plaque.

After factoring out differences in blood pressure, diabetes, age, smoking and cholesterol status, body shape was a much better indicator of either calcium or plaque status than either simple weight or BMI numbers.

For men and women both, the bigger the belly in relation to the hips - otherwise called the waist-to-hip ratio (WHR) - the greater the likelihood of arterial calcium in the heart.

After dividing the participants into five groups based on WHRs, the authors observed that those with the largest WHRs were almost twice as likely to have coronary calcium as those with the smallest WHRs.

Even if your belt buckles somewhere between flat and fat, you're not home-free, the researchers say. That's because even incremental increases in waist-to-hip-ratio translated into small but steady increases in calcium deposits.

Those with the largest waist-to-hip ratios were also three times as likely to have atherosclerotic plaque as those in the smallest waist-to-hip group, the researchers note.

Although higher BMI and waist circumference readings alone were also associated with signs of atherosclerosis, waist-to-hip ratios were found to be much stronger indicators of either calcium or plaque buildup.

Linked to Inflammation and Plaque

The research team led by de Lemos notes that BMI, in particular, does not gauge body composition. That's because BMI fails to account for the fact that abdominal fat - as opposed to fat around the hips - may be much less healthy.

Abdominal fat appears to trigger a chain of inflammatory activities that translates into harmful metabolic changes, plaque build-up and heart disease.

"The good news for patients is that it's not an 'all or nothing' situation," says de Lemos. "Even little improvements in your body shape are going to prove beneficial, with the goal being the smallest waist relative to your hips that you can have - without becoming anorexic, obviously."

"It's not rocket science," he adds. "It's the kind of thing you work on by incorporating regular routine exercise into everyday living.

"Nothing heroic, mind you," he says. "Just some exercise and developing good eating habits. And most of that revolves around moderation."

It's not about crash diets. It's about learning portion control, notes de Lemos. "So the best thing we can do is unlearn everything our parents taught us. Meaning, we should definitely not finish everything on our plate."

Cardiologist Dr. Curtis M. Rimmerman at the Cleveland Clinic describes de Lemos' work as a "start in the right direction" toward refining heart disease screening methods.

"I wouldn't say this finding is surprising," says  Rimmerman. "But it is certainly a reasonable assertion to suggest, given limited healthcare resources, that healthcare advisors focus on central-weight distribution rather than weight alone."

Mary Lou Perry, R.D., M.S., CDE, a nutritionist at the University of Virginia Health System's Heart & Vascular Center, suggests you ask for a measure of your waist circumference and waist-to-hip ratio at each checkup with your doctor.

"These measures are noninvasive, inexpensive and yield a lot of information," Perry says. 

For people who need to improve their WHR, Perry says there isn't a specific way to target fat around your midsection. But any move toward healthier eating and more exercise, she says, will lead to weight loss throughout your body - including a smaller pot belly.

To eat healthier, Perry recommends making small changes that you can stick with.

Here are some dietary tips from Perry:

• Eat smaller portion sizes and skip dessert
• Eat fewer fried foods and saturated fat - for instance, by switching from whole milk to skim milk
• Eat one meatless meal per week
• Choose more whole grains such as brown rice and whole-wheat bread
• Eat at least five daily servings of fruits and vegetables
• Have a serving of fish each day - fish contains omega-3 fatty acids that are good for your heart
• Consume healthier fats such as olive and canola oils

"Eating a heart-healthy diet which includes lots of fresh vegetables, fruit, more fish and more monounsaturated fat would be of great benefit to those who have a high waist-to-hip ratio," Perry says.

Learn more about preventing heart disease, UVA's Heart & Vascular Center and heart health at www.uvahealth.com.   

Women can learn more about their unique risks for heart disease - and how to better manage those risks - through Live Red, UVA's new heart-health initiative. You'll learn how heart-attack symptoms can be different for women than for men, and you can take an online risk assessment to learn your personal heart disease risk factors.

There, you can sign up for Club Red, our free heart-healthy club for women. Benefits include tips from UVA healthcare providers and a gift package to help you live red in style.

Always consult your physician for more information.