Waistline may be predictor for cardiovascular disease

Women with larger waistlines were at higher risk for cardiovascular disease and other comorbidities.

Prevalence of cardiometabolic risk factors, especially dyslipidemia, obesity and high central adiposity, may place women at higher risk for cardiovascular disease.

Erin D. Michos, MD, MHS, assistant professor of medicine in the division of cardiology at Johns Hopkins University School of Medicine, is calling for women with a waistline measurement >35 inches to get an annual check-up and detailed risk assessment for heart disease.

“Physicians and others have unfortunately become too accustomed to seeing heavyset people, and there is a risk that we overlook or dismiss being overweight and obesity as a potential and future source of heart problems,” Michos said in a press release. “Even if the problems are not evident now, it is more important to start screening women at a younger age to forego heart problems late in life.”

Researchers from various U.S. sites conducted a study to identify the prevalence and awareness of cardiovascular disease risk factors, obesity and coronary heart disease risk classification among 8,936 women who participated in the 2006 Sister to Sister National Woman’s Heart Day event. The mean age of participants was 49 years.

Waistline was a predictor

“Abdominal obesity, in particular, was associated with a more adverse lipid profile and elevated blood glucose,” Michos told Endocrine Today. “Thus, waist circumference in women may be a more important marker of obesity than weight or even BMI.”

Thirty-nine percent of participants were overweight (BMI 25-30), 35% were obese (BMI >30 kg/m²) and 55% had a waist circumference >35 in. As classified by the Framingham Risk Score, 85% of women were low risk, 6% were intermediate risk and 9% were high risk.

When waist circumference was included, 59% of low-risk women and 50% of intermediate-risk women had one or two risk factors; 19% of low-risk women and 41% of intermediate-risk women had >3 risk factors, according to the study.

“Women who exercise and put on muscle mass might feel frustrated by not seeing their weight change on the scale, but if they measure their waist circumference and see that they are losing inches there, then they are making a difference in reducing their heart disease risk, even if their overall weight is not changing too much,” Michos said.

Among women without a previous diagnosis of dyslipidemia, 48% were given new diagnoses. Among women without a previous diagnosis of hypertension, 7% were given new diagnoses. The participants were often unaware of risk factors on screening.

“I urge all women to ‘know their numbers,’ which not only includes blood pressure, cholesterol profile and glucose, but also BMI and waist circumference,” Michos said. “The best intervention is prevention.” – by Christen Haigh

J Womens Health. 2008;17:947-953.

This article provides us with another opportunity to enhance awareness of cardiovascular risk factors among women. The importance of waist circumference as a risk factor for cardiovascular disease has been well-recognized as evidenced by its presence among the components defining the metabolic syndrome by several organizations. The benefit of appreciating waist circumference as a risk factor for cardiovascular disease is that women can perform this measurement and track it themselves more regularly than other clinical measures such as blood pressure or laboratory testing.

– Rhonda Bentley-Lewis, MD, MBA, MMSc

Associate physician
Brigham and Women’s Hospital, Boston

Prevalence of Traditional Risk Factors on Screening

Non-HDL ?160 mg/dL	27%
HDL ?40 mg/dL	16%
Random glucose level ?140 mg/dL	6%
Uncontrolled blood pressure ?140/90 mm Hg	12%
Current smoking	6%
Positive family history of coronary heart disease	21%