For heart attack survivors, a fat belly could mean another one is likely, a new study suggests.
Earlier studies have shown that abdominal obesity puts people at risk for their first heart attack. This new study shows it also ups the odds for a second one, researchers say.
Healthy waist measurement
"Abdominal obesity not only increases your risk for a first heart attack or stroke, but also the risk for recurrent events after the first misfortune," said study author Dr Hanieh Mohammadi of Karolinska University Hospital in Solna, Sweden.
A healthy waist measurement is important for preventing future heart attacks and strokes, no matter how many preventive drugs you may be taking or how healthy your blood tests are, she said.
"Abdominal obesity can be tackled by eating a healthy and balanced diet and regular physical activity," Mohammadi said. "We also recommend that doctors and nurses measure waist circumference in clinical settings to identify first-time heart attack patients at increased risk of recurrent events."
Belly fat is dangerous because it's associated with conditions that accelerate clogging of arteries, including high blood pressure, high blood sugar and diabetes as well as raised levels of cholesterol, she said.
Yet, these conditions don't paint the whole picture, because abdominal obesity is a risk factor all on its own, Mohammadi noted.
"This suggests that there are more negative mechanisms involved with abdominal obesity that are yet unknown," she said.
Reduced risk of events
Dr Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said it's not certain that weight loss alone will lower the risk of another heart attack.
"Whether strategies to decrease abdominal adiposity [belly fat] in patients after myocardial infarction [heart attack] will translate to reduced risk of events requires prospective clinical trials," said Fonarow, who wasn't part of the research.
For the study, Mohammadi and her team followed more than 22 000 people in Sweden who had a first heart attack.
Among men, 78% had abdominal obesity, as did nearly 90% of the women. Abdominal obesity was defined as a waist measurement of 37 inches for men and 31.5 for women.
Over nearly four years of follow-up, the researchers found that abdominal obesity was independently linked to fatal and non-fatal heart attacks and strokes.
The risk from abdominal obesity was independent of other factors, such as smoking, diabetes, high blood pressure, cholesterol and overall weight.
The risk for a second heart attack linked to abdominal obesity was higher among men than women. But because fewer women were in the study than men, more investigation is needed to explain the difference in risk, the researchers said.
No specific targeted therapies
Abdominal obesity in men may consist of visceral fat, which sits around the organs. It's more dangerous than subcutaneous fat in women that sits just below the surface and is less harmful.
The findings were published in the European Journal of Preventive Cardiology.
"This study outlined an easily identifiable risk marker with a prognostic factor not previously known," said Dr Daniel Matos, of the Hospital de Santa Cruz in Lisbon, Portugal.
Currently, no specific targeted therapies for abdominal fat exist besides weight loss, diet and lifestyle changes, said Matos, who co-authored an editorial that accompanied the study.
"Not only does this article reinforce the necessity of abdominal fat reduction through weight loss, but also hypothesises that in the future, specific therapeutic approaches targeting abdominal fat may have a positive impact on the outcomes of these post-myocardial infarction patients," he said.
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