A new study shows that belly fat in patients with heart disease can double their death risk.
Mayo Clinic researchers analyzed data from nearly 16,000 people with coronary artery disease in five studies around the world.
Francisco Lopez-Jimenez, the project's lead investigator and director of the Cardiometabolic Program at the Mayo Clinic, said patients with coronary artery disease who carry even modest amounts of fat around their waists are at a higher risk of dying than people who store fat in other parts of the body.
That is equivalent to the risk of smoking a pack of cigarettes per day or having very high cholesterol, particularly for men.
"With this study, what we proved, is that fat actually matters," Lopez-Jimenez said. "But the most important thing is to measure where the fat is more than the total weight of an individual."
Lopez-Jimenez said that's because belly fat releases more fatty acids and substances in the blood stream that ultimately affect the heart and the arteries.
Lopez-Jimenez said the effect was observed even in patients with a normal Body Mass Index (BMI).
The researchers say physicians should counsel coronary artery disease patients who have normal BMIs to lose weight if they have a large waist circumference or a high waist-to-hip ratio.
"We suspected that the obesity paradox was happening because BMI is not a good measure of body fatness and gives no insight into the distribution of fat," said Thais Coutinho, M.D., the study's lead author and a cardiology fellow at Mayo Clinic. "BMI is just a measure of weight in proportion to height. What seems to be more important is how the fat is distributed on the body."
The research subjects included patients from the U.S., Denmark, France and Korea.
The Mayo Clinic findings were published in the Journal of the American College of Cardiology.