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Apple-Shaped Obesity, Other Forms Equally Risky, Study Finds

All Obesity Boosts Cardiovascular Risks, Researchers Say

Obesity and Heart Disease: Study Results

The findings contradict the widely held idea that people with apple-shaped obesity are at higher risk than others for heart attack and stroke, Di Angelantonio says.

''Either BMI [which measures general obesity] or waist circumference or waist-to-hip ratio [a reflection of central obesity] have a similar association with the risk of cardiovascular disease," he says.

They found, too, that if information on blood pressure and cholesterol is available, along with information on risk factors such as diabetes, those are enough to predict cardiovascular disease risk. "You don't need to measure anything else," he says.

The Emerging Risk Factors Collaboration Coordinating Centre is supported by grants from the British Heart Foundation, the U.K. Medical Research Council, and other sources.

Di Angelantonio reports no disclosures, but some co-authors report serving as consultants or receiving lecture payments or research grants from pharmaceutical companies.

Obesity and Heart Disease Prediction: Perspective

Rachel Huxley, DPhil, associate professor at the University of Minnesota School of Public Health in Minneapolis, wrote a commentary to accompany the report.

The new research, she tells WebMD, hopefully will lay to rest which obesity measure is best for predicting risk. "It had been hypothesized that measures of central obesity such as waist and waist-hip ratio would be more strongly associated with cardiovascular risk than measures of global obesity (that is, BMI)," she says. This thinking developed, she says, because in some studies, central obesity measures were more strongly linked with such conditions as type 2 diabetes, which in turn can boost heart disease.

The new research, she says, shows otherwise, suggesting that after adjusting for differences in age, gender, and smoking, ''there is very little difference between the three measures in terms of the strength of the relationship with cardiovascular disease."

The message, she says, is to maintain a healthy body weight -- meaning a BMI of 18.5 to 24.9. Experts say disease risk increases when a woman's waist circumference is over 35 inches and a man's is over 40 inches. To reduce disease risk, a woman's waist-to-hip ratio (waist in inches divided by hips in inches) should be 0.8 or less, a man's 0.9 or less.

Obesity and Heart Disease: Heart Association View

The findings send an important message, but the conclusions may not be the last word, says Tracy Stevens, MD, a spokeswoman for the American Heart Association and cardiologist at St. Luke's Hospital in Kansas City, Mo.

"I think one of the important things the study stresses is that just because you're pear-shaped doesn't mean you aren't going to have heart disease," she tells WebMD.

But Stevens points to many previous studies finding that the more central the fat, the more the risk of cardiovascular disease. "Can we confidently say that this study shows apples and pears are at the same risk? I think there is still credibility to the prior studies."

It is important, she says, not only to look at obesity but also to look at the other risk factors for cardiovascular disease, such as high blood pressure.

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