Are you an apple or a pear? Your shape may determine your health

Posted April 11

Dr. J. Brent Muhlestein, a cardiologist and expert heart researcher, didn't expect a recent study that he helped author to hit so close to home.

The study, released Saturday at the 2016 American College of Cardiology Scientific Session in Chicago, showed that people with apple-shaped bodies are at higher risk of developing heart disease than those with pear-shaped bodies.

It's the fat around the abdomen — not the hips — that is the best predictor of heart disease, Muhlestein found.

"For those of us who happen to have an apple shape rather than a pear shape, it is perhaps even more important that we aggressively attack it," he said.

The results resonated personally for the heart doctor, who has waged a long and well-documented battle against his own weight.

"It's a lot easier to become an accomplished cardiologist than it is to stay skinny for some people," Muhlestein jokes.

Muhlestein's study was one of several presented by researchers from Intermountain Medical Center in Murray in Chicago. Here's a look at three of the studies that may have real-world implications for your family — and perhaps even your doctor.

Apple vs. pear

Researchers know from previous studies that abdominal fat is associated with plaque buildup in the arteries.

But Muhlestein is one of the first to look into how abdominal fat is connected to heart function.

Using CT scans of patients' hips and waists, researchers found that waist fat is a better predictor of heart disease than hip fat, body weight or body mass index.

Fat around the waist produces more inflammation than other types of fat, Muhlestein said, and inflammation appears to be linked to heart function.

"We're going to keep looking and see what we're going to learn about this," Muhlestein said. "For me, it's bringing up whole new ideas."

For men, the rule of thumb is to keep their waist circumference below 40 inches; for women, below 35 inches.

For patients and doctor alike, maintaining regular exercise and a healthy diet is an important and natural way to reduce your apple shape, according to Muhlestein.

"I'm one of those apple sort of guys, and so I'm certainly going to try to keep my waist circumfrence less than 40," said Muhlestein. "Right now it's just about 39. But 39 is very close to 40."

Depression and stress

Research from Intermountain Heart Institute epidemiologist Heidi May suggests that taking care of your mental health may be just as important as your physical health when it comes to heart disease.

May surveyed patients over several years about their levels of depression and tracked whether they had events like stroke, heart failure or heart attack.

She found that patients who became depressed or remained depressed throughout the study had a 50 percent increase in risk of cardiovascular complications.

"This study tells us that it's important to screen for depression and treat it effectively," she said.

May said the link can be both behavioral and biological. On the one hand, people who are depressed may be less likely to exercise or keep up with their medication. But depression has also been linked to higher levels of inflammation and poorer blood vessel function.

Primary care clinicians should treat depression seriously and adopt standardized mental health surveys for patients, May said. She said people should also look out for family members or friends who seem depressed and encourage them to get evaluated.

On average, depressed patients suffered a cardiovascular event nine months to a year after their last survey, May said.

"There's been kind of a stigma with depression in the past, so I hope people feel like they can really talk to their doctor or family member about these feelings they have," May said.

More sun, stronger heart

May also authored a paper about vitamin D, a compound that most people get from exposure to sunlight or taking supplements.

May found that low levels of vitamin D are associated with major harmful events such as death, heart attack and stroke.

Patients with the lowest vitamin D levels had a 25 percent increase in risk compared to those in the top quartile, according to May.

She measured how much vitamin D is circulating in the body as well as how much is actually available to be used by the body — and found that both are strong predictors of heart health.

To prove a cause-and-effect relationship, researchers will need to set up a randomized clinical trial — something that May is now pursuing.

Questions remain about whether people need to reach a target level to get the benefits of vitamin D or whether they can get gradual benefits by partially supplementing.

Patients should talk to their doctors "about what their level means and if they think that supplementation might be beneficial for them," May said.


Heart studies


Twitter: DaphneChen_


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