CVD risk in postmenopausal women with excess abdominal fat, normal BMI

By Nicole MacKee
Postmenopausal women with a normal body mass index (BMI) but excess abdominal fat may be at increased risk of cardiovascular disease (CVD), say researchers in the European Heart Journal.

Their study included 2683 postmenopausal women with normal BMI (18.5 to less than 25 kg/m2) and no known CVD at baseline.

After almost 18 years’ follow up, the researchers found that higher deposits of abdominal fat were associated with almost twice the risk of CVD of the lowest abdominal fat deposits (hazard ratio [HR], 1.91, highest vs lowest quartile).

Higher deposits of leg fat, however, were associated with a reduced risk of CVD (HR, 0.62). And having a higher percent of abdominal fat and lower percent leg fat was associated with a particularly high risk of CVD (HR, 3.33).

Professor Susan Davis, Endocrinologist and Professor of Women’s Health at Monash University, Melbourne, said it was well established that abdominal fat put women at increased risk of CVD, regardless of their BMI. She said separate research had also shown an association with an increased risk of breast cancer (Int J Cancer 2017; 140: 2657-2666).

‘We have known for a long time that abdominal fat is what you should worry about,’ Professor Davis said, adding that she had conducted research showing that leg and abdominal fat had different metabolic characteristics.

‘Leg fat is more metabolically favourable, whereas central fat is metabolically sinister,’ she said. ‘Once you get fat infiltration of the liver as well, you see disturbed liver function tests, and cholesterol and metabolic changes.’

Although the mechanism affecting changes in fat distribution after menopause remained unclear, Professor Davis said oestrogen had been shown to have a metabolic effect that encouraged peripheral fat and discouraged central fat.

With 65% of Australian women over 50 years now overweight or obese, she said it was time to have some difficult conversations with patients about their eating habits.

‘Most people are overweight, but it’s very uncool for clinicians to tell people they are overweight,’ she said, adding that there had been a focus on encouraging people to exercise more, but most people needed to eat less.

‘Even if a patient is not “overweight”, but has excess abdominal fat, it is okay to tell them that they need to lose weight. It’s much easier to lose a couple of kilos than it is to lose 10,’ she said.

Young women too were at risk, Professor Davis said, with her group’s recent research showing that, among almost 7000 women aged 18 to 39 years, 22% were overweight and 24% were obese (Aust N Z J Obstet Gynaecol 2019; 1-8).

‘This is unprecedented ill health in the population.’
Eur Heart J 2019; doi: 10.1093/eurheartj/ehz391.