Your body shape may play a role, researchers say.

August 03, 2017

You already know that fat around your midsection—aka visceral fat—is more dangerous than fat stored elsewhere on the body, because it surrounds your organs and releases compounds that contribute to inflammation. But that same type of visceral fat can also accumulate in a hidden location that may be just as harmful, if not more so: around the heart.

People who have excess fat surrounding this vital organ—a scenario sometimes referred to as fatty heart—are at increased risk for cardiovascular disease and sudden cardiac events. Now, researchers are shedding some light on who is most likely to have this dangerous but invisible condition.

In a new study in the journal Menopause, University of Pittsburgh researchers analyzed data from physical exams and chest scans of 524 women in varying stages of menopause. The research focused on women in mid-life (average age 51), because previous studies have suggested that women tend to accumulate more cardiovascular fat later in life. The link between fatty heart and cardiovascular disease risk also seems to be stronger after menopause.

Fatty heart cannot be detected by observation or a standard physical exam; currently, the best way to diagnose it is with a CT scan, which is expensive and exposes patients to small amounts of radiation. The researchers wanted to know if easy-to-identify characteristics—like race and body composition—could also indicate whether women were at high risk of fatty heart, and related heart disease.

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The researchers adjusted their results to account for the potential effects of smoking, alcohol consumption, menopausal status, and socioeconomic factors. And as expected, they found that the more fat the women carried overall, the more fat they had around their hearts, as well.

But the researchers also found important differences between black and white women. White women with high body mass indexes (BMIs) had more fat around their hearts than black women with the same BMI. Meanwhile, black women with large waistlines had more fat around their hearts than white women with similar amounts of belly bulge.

In other words, a high BMI was more dangerous for white women, and carrying a spare tire was more dangerous for black women, says senior author Samar El Khoudary, PhD, associate professor of epidemiology at Pitt Public Health.

Additionally, the study identified another danger specific to black women with large waistlines: Their cardiovascular fat tended to be even closer to their hearts than the type accumulated by white women with high BMIs. The closer fat is to the organ, says El Khoudary, the more it can damage heart tissue with its inflammatory proteins.

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These findings mirrored the results of other research done by the same authors on men, and published in 2014. "This study, coupled with our previous study in men, gives doctors another tool to evaluate their patients and get a better sense of their heart disease risk,” says El Khoudary. “It also may lead to suggestions for lifestyle modifications to help patients lessen that risk.”

The medical community isn’t yet at a point where doctors routinely screen for fat around the heart, and more research is needed to determine the best treatment strategies, as well, says El Khoudary. More studies are also needed to understand the apparent paradox of why black men and women tend to have less cardiovascular fat overall, but still have higher rates of heart disease.

The authors also point out that, because they only looked at women's health data from one point in time, they could not determine how changes in BMI or waist circumference might affect levels of fat around the heart.  

For now, El Khoudary says the study highlights the connections between different types of fat in the body—and suggests that keeping off unwanted pounds all over may protect the heart from harmful fat accumulation, especially after menopause. “I want to emphasize the importance of following a healthy lifestyle, making sure people exercise and eat right,” she says. “The more we emphasize this, the more we are able to achieve a healthy weight and better health.”