Older women have higher heart disease risk with ‘apple’ shape

(Reuters Health) – Older women who are at a healthy weight may be more likely to develop heart disease when they carry excess fat around their midsection than when they store more fat in their hips and thighs, a new study suggests.

While being overweight has long been linked to a higher risk of heart disease, the risks associated with excess fat for people with a body mass index (BMI) in the healthy range aren’t as clear, researchers note in the European Heart Journal.

The current study involved 2,683 women who had already gone through menopause but didn’t have cardiovascular disease. Researchers followed half of the participants for at least 18 years.

Overall, 291 women developed heart disease. Women with the most belly fat, or an “apple” shape, were 91 percent more likely to develop heart disease than women with the least amount of fat around their midsection.

The risk was most pronounced for women who had lots of belly fat and very little fat on their thighs. These women were more than three times more likely to develop heart disease than women who had the opposite shape: fatter thighs and flatter stomachs.

“An `apple’ shape has been associated with increased heart risk in previous studies, but it mostly refers to central obesity among people already have a weight problem,” said Qibin Qi, senior author of the study and a researcher at Albert Einstein College of Medicine in Bronx, New York.

“Our study found, for the first time, that among postmenopausal women with normal body mass index (BMI), elevated trunk fat (apple shape) is associated with increased risk of cardiovascular disease, while elevated leg fat (pear shape) is associated with reduced risk of cardiovascular disease,” Qi said by email.

Women who had the most pronounced “pear” shape, with more fat on their thighs, were 38 percent less likely to develop heart disease during the study than women with the least amount of fat on their upper legs.

All of the women in the study had a healthy BMI ranging from 18.5 to 24.9.

When women go through menopause, they can also experience changes in their body shape and metabolism as more fat gets stored around the organs rather than right under the skin, the study authors note. The distribution of body fat can be shaped by genetics, as well as by eating and exercise habits.

The study wasn’t a controlled experiment designed to prove whether or how the location of excess fat in health-weight women might directly cause cardiovascular disease.

One limitation is that the participants were predominantly white, and results might differ for men or for women from other racial or ethnic groups.

It’s also not clear what dietary or exercise changes might help women shed fat specifically around their belly or shift where their body stores fat to transform their shape from an “apple” to a “pear,” Qi said.

“Unfortunately, it´s very difficult to increase leg fat at the expense of trunk fat,” said Dr. Matthias Bluher of the University of Leipzig in Germany, coauthor of an editorial accompanying the study.

“However, reducing trunk fat with a low calorie diet and regular exercise may be beneficial even if you are normal weight,” Blüher said by email.

SOURCE: bit.ly/306B3GL European Heart Journal, online June 30, 2019.