Your Waist Size Predicts Heart Disease Better Than BMI

by David Mendosa Patient Advocate

The size of your waist may predict whether you will get diabetic heart disease more effectively than the body mass index (BMI). And when it comes to either your waist or your body mass index, bigger isn’t better.

A collaborative team of nine researchers from the Intermountain Heart Institute in Salt Lake City and Johns Hopkins Hospital in Baltimore reported their findings this month at this year’s scientific sessions of the American College of Cardiology. I obtained a copy of the study and the poster presented at the scientific sessions from a representative of the institute.

A strong predictor

The researchers studied 200 men and women living with type 1 or type 2 diabetes who hadn’t showed any symptoms of heart disease. These patients were screened to assess regional left ventricular dysfunction, which is a common cause of heart disease, including congestive heart failure. The patients had a mean age of 60, and were equally divided among women and men. Their average weight was 210 pounds, waist circumference was 43 inches, and body mass index (BMI) was 32, which goes into the obese range.

In both genders, greater waist circumference was associated with “progressively worse global strain” and remained significant even after adjusting for age, gender, severity of coronary artery disease, coronary calcium score, high blood pressure, systolic blood pressure, and type of diabetes. In the researcher’s regression model, only waist circumference remained as an independent predictor of left ventricular dysfunction. Weight and BMI “became non-significant.”

The left ventricle is the chamber of the heart that pumps oxygen-rich blood to your brain and your body. When your left ventricle doesn’t function well, blood backs up into your lungs and legs, and as mentioned earlier, can often lead to heart failure and can increase your risk of sudden cardiac arrest.

The current study builds on earlier research by the same team at the Intermountain Heart Institute and Johns Hopkins Hospital. One of the team’s earlier studies showed that when you have diabetes, the higher your BMI, the greater your risk for getting heart disease.

Worse for men

The women in the study had better heart function at each increasing level of abdominal obesity than the men did. "In general, abdominal obesity had a greater adverse effect on men than women," Dr. Muhlestein said. He advises women to keep their waist size down to about 34 inches or less. Men should try to keep their waist circumference at 40 inches or less.

The new study supports the old theory that it's better to be shaped like a pear -- with weight around your hips -- than like an apple -- with weight around your stomach. This study emphasizes that having an apple shape can motivate you to reduce all of your cardiovascular risk factors, including your waist circumference, Dr. Muhlestein said.

No matter what your shape, it’s important to have an open dialogue with your doctor to assess your diabetes and/or diabetic heart risk. With the help of your doctor and health professionals, you can set up a health plan that works best for you.

David Mendosa
Meet Our Writer
David Mendosa

David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.