What’s the real culprit when it comes to heart disease? The debates centers around two main schools of thought: body shape, specifically those with an “apple” shape who carry extra weight in the tummy, versus those with general obesity and an overall high total body mass index or BMI. Proponents of both theories feel strongly regarding the research that supports their position. So, what’s the debate all about?
The “Apple” Body Shape Theory
One theory is that those with an apple shape are more likely to develop heart disease than those with other body types, such as a pear. Apple shapes carry extra weight in their mid-section whereas a pear body type carries excess weight in the hips and thighs. According to The Mayo Clinic, apple shapes are more likely to develop metabolic syndrome, diabetes, and heart disease. Metabolic syndrome occurs when you have at least three separate metabolic conditions such as high blood pressure, high “bad” triglycerides, low levels of “good” or high density lipoprotein blood cholesterol, and obesity, particularly when weight is carried around the mid-section. Conversely, those with pear shapes are believed to be at less risk of developing these same conditions.
According to a study published in the May 10, 2011 issue of the Journal of the American College of Cardiology, apple shapes fare worse than other body types when it comes to developing and surviving heart disease. The purpose of the study was to examine the association between waist circumference, waist-hip-ratio, and total obesity as they relate to mortality in patients with heart or coronary artery disease. In a multinational effort involving representatives from the United States, Denmark, Korea, and France, researchers attempted to solve the controversy of which is the greater predictor – body shape or body mass index - of mortality in patients with heart disease.
Researchers examined data from almost 16,000 patients with a prior diagnosis of coronary artery disease. The risk for those with an apple shape was determined by examining waist circumference as well as the waist-hip ratio. The body mass index ratio was used by researchers to determine the level of risk for those with general obesity. After completing their analysis, researchers found that those with an apple or “central” shape were two times more likely than their pear shaped counterparts to die of heart disease. The increase in risk for apple shapes held true even when BMI was within normal limits.
Despite the findings of this study, the controversy regarding the best predictor for heart disease and mortality continues. Next time, we’ll look at the role overall obesity or body-mass-index may play in heart disease.
Sources:
Central Obesity and Survival in Subjects With Coronary Artery Disease, J Am Coll Cardiol, 2011; 57-1877-1886, doi:10.1016/j.jacc.2010.11.058, http://content.onlinejacc.org/cgi/content/abstract/57/19/1877?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=apple+shape&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Dr. Sam Giris, M.D., Central Obesity is Associated With Increased Mortality in Patients with Heart Disease, drsamgiris.com, 03 May 2011, http://drsamgirgis.com/2011/05/03/central-obesity-is-associated-with-increased-mortality-in-patients-with-heart-disease/
Metabolic Syndrome: apple and pear body shapes, The Mayo Clinic, 05 Nov 2010, http://www.mayoclinic.com/health/medical/IM04175
Reviewed June 13, 2011
Edited by Alison Stanton