A heart expert at Johns Hopkins is calling for all women with
a waistline measuring more than 35 inches to get an annual
checkup and detailed risk assessment for heart problems
because excess abdominal fat, even in the mildly obese and
overweight, leads more than a third of women to underestimate
their lifetime risk of having a heart attack, stroke or chest
pain (angina).
Cardiologist Erin Michos, who made her pitch directly to
colleagues during a special lecture last week at The Johns
Hopkins Hospital, says that the recommendation is based on a
national, multicity screening of 8,936 women, ages 35 to 63,
for heart disease risk factors. The screening, she says,
found a strikingly high number of overweight American women
whose stretched girth was tied to a serious underestimation
of risk using traditional tools to assess heart health.
In a report published in the August issue of the Journal
of Women's Health, the research team showed that 39
percent of women screened were overweight (having a body mass
index between 25 and 30) and 35 percent were obese (having a
body mass index over 30, often overweight by more than 30
pounds). And when waistlines 35 inches and larger were
factored into the risk assessment, 55 percent of these women
were found to have hearts at increased risk of disease.
"It is time for physicians and patients to pull out their
measuring tapes and for overweight women in particular to
start shedding some pounds," says Michos, an assistant
professor at the School of Medicine and its Heart and Vascular
Institute.
She points out that traditional risk-factor scoring leaves
out waist size, taking into account only such factors as age,
blood pressure, blood cholesterol levels, smoking and
diabetes. These measures have long been used as part of the
Framingham Risk Assessment, which gauges people's 10-year
risk of heart disease.
But the team's latest assessments — drawn from a 2006
annual public screening in 14 communities across the United
States, in which women were asked to undergo a short physical
checkup and fill out a health questionnaire — changed
significantly when expanded waistlines were factored into
their calculations.
More than half (59 percent) of the 85 percent of women
originally thought to be at low risk of heart trouble were
now found to have one or two additional risk factors. And 19
percent of those at low risk and nearly half (41 percent) of
the women originally ranked at intermediate risk actually had
three or more previously unknown risk factors.
"These women have a high lifetime risk of cardiovascular
disease even though their 10-year risk may be predicted as
low," says Michos, who points out that the presence of a
single, major risk factor for heart disease by the age of 50
cuts back on women's median lifespan compared to women with
no risk factors.
"Our results really emphasize the growing epidemic of obesity
in America and showcase its potential for misreading or
masking future harm to women's heart health," she says. "Even
if they are not experiencing immediate problems, they could
soon be in trouble. Overweight people are more likely to
develop risk factors that lead to cardiovascular problems,
such as high blood pressure, blood sugar imbalances and
excess blood lipid levels. And the reverse is also true:
Losing weight, especially abdominal fat, is the first step in
lowering blood pressure and getting blood cholesterol levels
under control."
Michos notes that other research has shown a loss of just 5
pounds lowers people's risk of pre-diabetes by 31 percent.
Losing 10 pounds lowers blood pressure by 5 millimeters of
mercury.
Michos says she has started her campaign with local
physicians because it will take a few years to amass the
necessary additional evidence to change national clinical
guidelines. Results from the 2007 screenings, coordinated by
the Maryland-based Sister to Sister, Everyone Has a Heart
Foundation, will not be ready until later this year.
"Physicians and others have unfortunately become too
accustomed to seeing heavyset people, and there is a risk
that we overlook or dismiss being overweight and obesity as
a potential and future source of heart problems," Michos
says. "Even if the problems are not evident now, it is more
important to start screening women at a younger age to forgo
heart problems later in life.
"Community screening events have confirmed that many women
are unaware of their risk factors, and the screenings have
proven effective at identifying those women at risk and,
hopefully, we will be able to expand these programs in the
future," she says, noting that 48 percent of women with high
cholesterol levels were newly diagnosed with the condition,
as were 7 percent of women with hypertension.
"Awareness is the first step to implementing heart-healthy
lifestyle changes to reduce their risk," Michos says. The
next Sister to Sister community screening event will take
place in February.
Furthermore, Michos says that annual survey results, though
specific to women, also bear significance for men, for whom
a waistline greater than 40 inches is considered obese.
Researchers say their next steps are to monitor screened
women to see how well follow-up treatments worked at not only
lowering risk but also in lowering actual heart problems, and
whether or not this stretches out lifespan.
Of 150 women who were screened as high risk in 2006, 71
percent followed up with a visit to their physician, 64
percent changed diet, 47 percent lost weight, 61 percent
monitored their blood pressure levels, 6 percent stopped
smoking, and 23 percent checked their waistline against the
35-inch benchmark.
According to the latest statistics from the American Heart
Association, one in three American women has some form of
cardiovascular disease. Sixty-nine million women are
overweight, including more than 36 million who are obese.
Funding for this study was provided by the Sister to Sister,
Everyone Has a Heart Foundation. In addition to Michos,
researchers from the Johns Hopkins Ciccarone Preventive
Cardiology Center involved in this study and in the Sister to
Sister annual screenings were Brian Kral, Catherine Campbell,
M. Dominique Ashen and Roger Blumenthal. Other researchers
were Irene Pollin and Laurene McKillop, Sister to Sister;
Teresa Shattuck, Michele Debarthe Sadler and Karen Boyle,
Shattuck & Associates; Khurram Nasir, Massachusetts General
Hospital; Rita Redberg, University of California, San
Francisco; and Karlynn Brintzenhofeszoc, Catholic University
of America.