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Elderly Women: Where Fat Is Determines Heart
Attack Risk
 Men
don't live long enough for this study
Oct. 27, 2004 - For
elderly women, the location of body fat is more important than total fat
amount in predicting future heart attacks, according to researchers from
Wake Forest University Baptist Medical Center and colleagues.
"In the over-70 age
group, overall obesity did not predict heart attack risk," said Barbara
J. Nicklas, Ph.D., lead researcher. "It didn't matter how much fat the
older woman had – what mattered was where that fat was stored."
The researchers found
that intra-abdominal fat, or fat stored in and around the internal
organs, is most predictive of heart attack risk. The results are
reported in the current issue of the American Journal of Epidemiology.
"People with higher
levels of intra-abdominal fat tend to be apple-shaped rather than
pear-shaped" Nicklas said. "As we age, fat gets stored in the abdomen
more than anywhere else, which isn't good because it's now associated
with heart attacks. The best way to lose that fat is to lose overall
body fat through exercise and diet."
The study was conducted
in initially healthy 70- to 79-year-old men and women from Pittsburgh,
Pa., and Memphis, Tenn., who were enrolled in the Health, Aging and Body
Composition (Health ABC) Study. Individuals were eligible for the study
if they reported no life-threatening illness such as heart disease, as
well as no difficulty walking a quarter of a mile, climbing 10 steps or
performing basic activities of daily living.
At the beginning of the
study, the researchers measured total body fat as well as fat
distribution (waist-to-thigh ratio, waist circumference, and
intra-abdominal or visceral fat). Participants were contacted every six
months for the next 4½ years to collect data about hospitalizations or
major outpatient procedures for heart attack.
The research revealed
that intra-abdominal fat was a risk factor even if women did not have
any other risk factors for heart disease. "Women who had a heart attack
during the course of the study had approximately 27 percent more
intra-abdominal fat at the start of the study," said Nicklas. "This risk
factor was independent of total amount of body fat, diabetes, blood
pressure and blood lipid levels."
One surprising finding
from the study was that intra-abdominal fat was not a predictor of heart
attack in men ages 70 to 79. "None of the body fat measures were
predictors of heart attack in men," said Nicklas. "My theory is that men
who had high levels of fat would have experienced heart disease earlier
than in their 70s; therefore, they weren't eligible for our study. I
wouldn't be surprised if we did a study of men in their 50s and 60s in
which we would see abdominal fat as a strong risk factor for a future
heart attack."
Knowing more about
intra-abdominal fat as a risk factor for heart disease could lead to
early screening, said Nicklas. Waist size is one easy way to screen but,
according to the study results, may not be the most accurate.
"There are clinically
defined cut-points for waist size --35 inches for women and 40 inches
for men--that suggest a person is at higher risk for heart disease,"
Nicklas said. "However, in this study, waist size was not an accurate
predictor of heart attack."
The most accurate method
for measuring intra-abdominal fat is the more expensive computed
tomography (CT) scan. "From the scan, we could determine how much
abdominal fat was stored just underneath the skin versus how much was
stored in the abdominal cavity, or inside the muscle wall," Nicklas
said.
The research was funded
by grants from the National Institute on Aging, including the Wake
Forest University Claude D. Pepper Older Americans Independence Center.
Nicklas' co-researchers were Brenda Penninx, Ph.D, Matteo Cesari, M.D.,
Ph. D., Stephen B. Kritchevsky, Ph.D., Jingzhong Ding, Ph.D., and Marco
Pahor, M.D., all from Wake Forest Baptist, Anne B. Newman, M.D., from
the University of Pittsburgh, Alka M. Kanaya, M.D., from the University
of California at San Francisco, and Tamara Harris, M.D., from the
National Institutes of Health.
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