Apple-shaped women face greater risk of CVD than pear-shaped women

Body fat distribution could be a key predictor of heart disease risk in postmenopausal women, according to a July 1 study that found “apple”-shaped women are more prone to CVD than their “pear”-shaped counterparts.

Qibin Qi, PhD, and his colleagues studied fat distribution among 2,683 postmenopausal women enrolled in the Women’s Health Initiative, a program that was active from 1993 to 2017. All women in the study were considered at a healthy weight, logging initial BMIs between 18.5 and 25, and didn’t have any CVD symptoms at baseline.

After an average follow-up of 18 years, 291 women in the WHI subgroup experienced a heart event. Qi, an associate professor at the Albert Einstein College of Medicine, New York, and his team found participants with the highest percentage of fat around their middle and the lowest percentage of leg fat—“apple” shapes—saw a more than threefold increased risk of CVD compared to their counterparts with the least trunk fat and the most leg fat—“pear” shapes.

Analyses revealed that women in the top 25% of those who stored the most fat around their middle had nearly double the risk of heart disease and stroke when compared to the 25% of women with the least fat stored in their torso area. The top quartile of women with the greatest proportion of fat stored in their legs also had a 40% lower risk of CVD compared to women who stored the least fat in their legs.

“Our findings suggest that postmenopausal women, despite having normal weight, could have varying risk of cardiovascular disease because of different fat distributions around either their middle or their legs,” Qi said in a release. “In addition to overall body weight control, people may also need to pay attention to their regional body fat, even those who have a healthy body weight and normal BMI.”

The researchers calculated that, for every 1,000 women who kept their leg fat constant but reduced their proportion of trunk fat from more than 37% to less than 27%, six CVD cases could be avoided each year. That translates to 111 cases over the course of the study’s 18 years of follow-up.

Qi said it’s important to note that he and his colleagues’ study population comprised of postmenopausal women who naturally had higher fat mass in both their trunk and leg regions than younger women, meaning their findings might not be generalizeable to other age groups. 

“Our findings highlight the need for using anthropometric measures that better reflect regional fat distribution to identify increased risk of cardiovascular disease,” he said. “These are important research directions for future population studies.

“In the next step, our group will focus on the long-term impacts of dietary habits on fat distribution among these postmenopausal women, and evaluate whether and how dietary habits may affect multiple health risks, such as risk of cancer, cardiovascular disease and premature death, through the impacts on the distribution of body fat.”

Qi et al.’s work was published this month in the European Heart Journal.