Apple Shape Predicts Heart Attack Risk Better than BMI

Roger Zoul said:

A pot belly increases the risk of a heart attack -- even if the rest of the
physique is as skinny as a beanpole

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3237

One sentence reads:

"Dr. Sharma and colleagues showed last year with Interheart data that
abdominal obesity accounts for about 90% of the risk for myocardial
infarction around the world, with eight other risk factors -- including
cigarette smoking, diabetes, poor diet, and lack of exercise --
accounting for the rest."

The researchers appear to be genuine and the results were published in
The Lancet, nonetheless I find the above assertion astonishing and I
wonder whether there has been some misinterpretation. Any thoughts
anyone?

Anthony <[email hidden]> wrote:
:> Roger Zoul wrote:
:>> A pot belly increases the risk of a heart attack -- even if the
:>> rest of the physique is as skinny as a beanpole
:>>
:>>
http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3237
:>
:> One sentence reads:
:>
:> "Dr. Sharma and colleagues showed last year with Interheart data that
:> abdominal obesity accounts for about 90% of the risk for myocardial
:> infarction around the world, with eight other risk factors --
:> including cigarette smoking, diabetes, poor diet, and lack of
:> exercise --
:> accounting for the rest."
:>
:> The researchers appear to be genuine and the results were published
:> in
:> The Lancet, nonetheless I find the above assertion astonishing and I
:> wonder whether there has been some misinterpretation. Any thoughts
:> anyone?

Why? I find them totally believable. I would like to get my mitts on the
actual article, though. Anyone know how (other than paying for a
subscription)?

Roger Zoul said:

Why? I find them totally believable. I would like to get my mitts on the
actual article, though. Anyone know how (other than paying for a
subscription)?

I understand it to say that only 10% of risk for MI comes from a
combination of smoking, diabetes, diet and lack of exercise and all the
rest from having a fat tum. Does that really seem right to you, and if
so do you think that all that cardio exercise is largely a waste of
time.

I'd also like to see the original article, soo if you find a way please
post it.

Anthony <[email hidden]> wrote:
:> Roger Zoul wrote:
:>>
:>> Why? I find them totally believable. I would like to get my mitts
:>> on the actual article, though. Anyone know how (other than paying
:>> for a subscription)?
:>
:> I understand it to say that only 10% of risk for MI comes from a
:> combination of smoking, diabetes, diet and lack of exercise and all
:> the rest from having a fat tum. Does that really seem right to you,
:> and if
:> so do you think that all that cardio exercise is largely a waste of
:> time.

Given that we're talking about MI, no, it doesn't seem weirdly "off" to me.
Those other things can obviously contribute to other health problems,
though. As far as exercise goes, if a person can remain trim then I don't
see why lack of exercise would contribute much to MI.

:>
:> I'd also like to see the original article, soo if you find a way
:> please post it.

I will. I'd hate to pay $30 for a single day sub, though.

Anthony <[email hidden]> wrote:
:> Roger Zoul wrote:
:>>
:>> Why? I find them totally believable. I would like to get my mitts
:>> on the actual article, though. Anyone know how (other than paying
:>> for a subscription)?
:>
:> I understand it to say that only 10% of risk for MI comes from a
:> combination of smoking, diabetes, diet and lack of exercise and all
:> the rest from having a fat tum. Does that really seem right to you,
:> and if
:> so do you think that all that cardio exercise is largely a waste of
:> time.
:>
:> I'd also like to see the original article, soo if you find a way
:> please post it.

I'd be happy to e-mail the article to you, if you give me permission and a
valid e-mail address. I believe the copyright permits this for individual
use.

"Anthony" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

One sentence reads:

"Dr. Sharma and colleagues showed last year with Interheart data that
abdominal obesity accounts for about 90% of the risk for myocardial
infarction around the world, with eight other risk factors -- including
cigarette smoking, diabetes, poor diet, and lack of exercise --
accounting for the rest."

The researchers appear to be genuine and the results were published in
The Lancet, nonetheless I find the above assertion astonishing and I
wonder whether there has been some misinterpretation. Any thoughts
anyone?

Yes, I noted that assertion too. What they seem to be *trying* to say is
that the *association* between apple shape and MI is higher than that
between MI and the other named risk factors. It isn't saying that the
abdominal fat *causes* the MI, though.

Look at it this way. Assume that MI is very much associated with the whole
insulin resistance/hyperinsulimia/Syndrome X thing. One of the primary
indications of insulin resistance is... yep, apple shape/abdominal fat. Many
people with IR are diabetic, but many are not, and many will have their
first MI before they become diabetic. Therefore, you'd expect the
correlation between apple shape and MI to be stronger than that between
diabetes and MI.

As for those other factors, many people with IR smoke, fail to exercise, and
smoke cigarettes. But many people who do those things aren't IR, because
they are young and/or they are not genetically predisposed. That also
lessens the correlation between those health factors and MI.

In fact, if you look at it this way, this study appears to be doing little
more than reiterating the very strong correlation between heart disease and
IR, hyperinsulin, or Syndrome X (whatever you want to call this condition).
Not really news.

HG

Hannah Gruen <[email hidden]> wrote:
:> "Anthony" <[email hidden]> wrote in message
:> news:[email hidden]...
:>> One sentence reads:
:>>
:>> "Dr. Sharma and colleagues showed last year with Interheart data
:>> that abdominal obesity accounts for about 90% of the risk for
:>> myocardial infarction around the world, with eight other risk
:>> factors -- including cigarette smoking, diabetes, poor diet, and
:>> lack of exercise --
:>> accounting for the rest."
:>>
:>> The researchers appear to be genuine and the results were published
:>> in
:>> The Lancet, nonetheless I find the above assertion astonishing and I
:>> wonder whether there has been some misinterpretation. Any thoughts
:>> anyone?
:>
:> Yes, I noted that assertion too. What they seem to be *trying* to
:> say is that the *association* between apple shape and MI is higher
:> than that between MI and the other named risk factors. It isn't
:> saying that the abdominal fat *causes* the MI, though.
:>
:> Look at it this way. Assume that MI is very much associated with the
:> whole insulin resistance/hyperinsulimia/Syndrome X thing.

That could be tricky.

One of the
:> primary indications of insulin resistance is... yep, apple
:> shape/abdominal fat. Many people with IR are diabetic, but many are
:> not, and many will have their first MI before they become diabetic.
:> Therefore, you'd expect the correlation between apple shape and MI
:> to be stronger than that between diabetes and MI.
:>
:> As for those other factors, many people with IR smoke, fail to
:> exercise, and smoke cigarettes. But many people who do those things
:> aren't IR, because they are young and/or they are not genetically
:> predisposed. That also lessens the correlation between those health
:> factors and MI.
:>
:> In fact, if you look at it this way, this study appears to be doing
:> little more than reiterating the very strong correlation between
:> heart disease and IR, hyperinsulin, or Syndrome X (whatever you want
:> to call this condition). Not really news.

The study is saying that WHR is better indicatior than BMI as a risk factor
for HI. All the others factors you mention are inferences.

:>
:> HG

Hannah Gruen said:

Yes, I noted that assertion too. What they seem to be *trying* to say is
that the *association* between apple shape and MI is higher than that
between MI and the other named risk factors. It isn't saying that the
abdominal fat *causes* the MI, though.

In USA Today today the study was interpreted to mean that smoking,
diabetes, diet, exercise, high BP and fat tum accounted for 90% of the
MI risk and the rest, genetics and such, for 10%. This sounds more
reasonable to me.

Anthony <[email hidden]> wrote:
:> Hannah Gruen wrote:
:>>
:>> Yes, I noted that assertion too. What they seem to be *trying* to
:>> say is that the *association* between apple shape and MI is higher
:>> than that between MI and the other named risk factors. It isn't
:>> saying that the abdominal fat *causes* the MI, though.
:>>
:> In USA Today today the study was interpreted to mean that smoking,
:> diabetes, diet, exercise, high BP and fat tum accounted for 90% of
:> the MI risk and the rest, genetics and such, for 10%. This sounds
:> more reasonable to me.

I find no mention of the 90% in the actual paper, ie, the researchers didn't
say it there if they said it at all.

nanner <[email hidden]> wrote:
:> "Roger Zoul" <[email hidden]> wrote in message
:> news:[email hidden]...
:>>A pot belly increases the risk of a heart attack -- even if the rest
:>>of the physique is as skinny as a beanpole
:>>
:>>
http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3237
:>>
:>
:> I didn't read the article but isn't it old news that the Apple shaped
:> over-weight person is at greater risk of health problems (such as
:> heart disease) than the Pear shaped over-weight person?

From the paper:
"On the basis of two previous smaller studies,10,11 we had postulated that
markers of central obesity (especially the waist-to-hip ratio) would be more
strongly related to the risk of myocardial infarction than BMI (the
conventional measure). We aimed to investigate the relation of BMI, waist
and hip circumferences, and waist-to-hip ratio to the risk of myocardial
infarction using data from the INTERHEART study,12,13 of about 15 000 cases
and a similar number of controls representing many ethnic groups."

Anthony <[email hidden]> wrote:
:> Hannah Gruen wrote:
:>>
:>> Yes, I noted that assertion too. What they seem to be *trying* to
:>> say is that the *association* between apple shape and MI is higher
:>> than that between MI and the other named risk factors. It isn't
:>> saying that the abdominal fat *causes* the MI, though.
:>>
:> In USA Today today the study was interpreted to mean that smoking,
:> diabetes, diet, exercise, high BP and fat tum accounted for 90% of
:> the MI risk and the rest, genetics and such, for 10%. This sounds
:> more reasonable to me.

This statement:
"Dr. Sharma and colleagues showed last year with Interheart data that abdominal obesity accounts for about 90% of the risk for myocardial infarction around the world, with eight other risk factors -- including cigarette smoking, diabetes, poor diet, and lack of exercise -- accounting for the rest. "
from http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3237

is wrong.

From a pervious paper coming out of the INTERHEART Study (2004) one finds (along with other related statements)
"Incorporation of all nine independent risk factors (current or former smoking, history of diabetes or hypertension, abdominal obesity, combined psychosocial stressors, irregular consumption of fruits and vegetables, no alcohol intake, avoidance of any regular exercise, and raised plasma lipids) indicates an odds ratio of 129·20 (99% CI 90·24-184·99; table 3), compared with not having any of these risk factors. Substituting the odds ratios for current smoking, the extremes of abdominal obesity (top vs lowest tertile) and ApoB/ApoA1 ratio (top vs lowest quintile) increases the combined effect of all nine risk factors to 333·7 (99% CI 230·2-483·9; figure 2). This represents a PAR of 90·4% (99% CI 88·1-92·4), suggesting that these risk factors account for most of the risk of acute myocardial infarction in our study population. In view of the overlap in the effect of the nine risk factors, most of the PAR could be accounted for by a combination of various risk factors, as long as they included smoking and the ApoB/ApoA1 ratio (PAR for their combination is 66·8% [99% CI 62·8-70·6]). The estimate of the combined effect of all nine risk factors is derived from a model, since very few individuals had zero risk factors or all nine risk factors. However, confidence that the majority of risk is indeed accounted for by these risk factors is lent support by the fact that of the 18 708 individuals with complete data on all risk factors, 43 controls and 24 cases had no risk factors and 49 cases and 11 controls had eight or more. Also, just five risk factors (smoking, lipids, hypertension, diabetes, and obesity), which a large proportion of individuals had, accounted for about 80% of the PAR."

where PAR = population attributable risks

So, Anthony, you were correct.

"Roger Zoul" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

A pot belly increases the risk of a heart attack -- even if the rest of the
physique is as skinny as a beanpole

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=3237

I didn't read the article but isn't it old news that the Apple shaped
over-weight person is at greater risk of health problems (such as heart
disease) than the Pear shaped over-weight person?

Roger Zoul said:

Anthony <[email hidden]> wrote:
:> Roger Zoul wrote:

:> The researchers appear to be genuine and the results were published
:> in
:> The Lancet, nonetheless I find the above assertion astonishing and I
:> wonder whether there has been some misinterpretation. Any thoughts
:> anyone?

Why? I find them totally believable. I would like to get my mitts on the
actual article, though. Anyone know how (other than paying for a
subscription)?

Medical Centers and University Libraries

You can often use the library, if they have one, at your local medical
center. Call ahead to verify :

1) Yes, they have a library
2) Yes, you can come in to use it
3) Yes, they have that journal (Lancet) in the library.

If you are near a university with a medical school, you can generally
freely go in (after paying for parking) and make a copy of the journal
article for a reasonable fee. Most of my experience like this was with
California universities, including the private Cal Tech university.

You can also often get a reprint from the author. It helps if you
contact them by mail or email.

Since time is money, you can see why high fees for journal articles make
sense for the publisher.

--
1) Eat Till SATISFIED, Not STUFFED... Atkins repeated 9 times in the book
2) Exercise: It's Non-Negotiable..... Chapter 22 title, Atkins book
3) Don't Diet Without Supplimental Nutrients... Chapter 23 title, Atkins
book
4) A sensible eating plan, and follow it. (Atkins, Self Made or Other)

jbuch <jbuch@CUT_HERE.revealed.net> wrote:
:> Roger Zoul wrote:
:>> Anthony <[email hidden]> wrote:
:>> :> Roger Zoul wrote:
:>>
:>> :> The researchers appear to be genuine and the results were
:>> :> published
:>> :> in
:>> :> The Lancet, nonetheless I find the above assertion astonishing
:>> :> and I wonder whether there has been some misinterpretation. Any
:>> :> thoughts anyone?
:>>
:>> Why? I find them totally believable. I would like to get my mitts
:>> on the actual article, though. Anyone know how (other than paying
:>> for a subscription)?
:>>
:>>
:>
:> Medical Centers and University Libraries
:>
:> You can often use the library, if they have one, at your local
:> medical center. Call ahead to verify :
:>
:> 1) Yes, they have a library
:> 2) Yes, you can come in to use it
:> 3) Yes, they have that journal (Lancet) in the library.
:>
:> If you are near a university with a medical school, you can generally
:> freely go in (after paying for parking) and make a copy of the
:> journal article for a reasonable fee. Most of my experience like
:> this was with California universities, including the private Cal
:> Tech university.
:>
:> You can also often get a reprint from the author. It helps if you
:> contact them by mail or email.
:>
:> Since time is money, you can see why high fees for journal articles
:> make sense for the publisher.

Thanks. I ended up doing just this (more or less)! 🙂

"Roger Zoul" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Hannah Gruen <[email hidden]> wrote:
:> Look at it this way. Assume that MI is very much associated with the
:> whole insulin resistance/hyperinsulimia/Syndrome X thing.

That could be tricky.

Do you really think there is a lot of controversy over the association
between IR/Syndrome X and heart disease/MI?

Quoted message said:

The study is saying that WHR is better indicatior than BMI as a risk
factor for HI. All the others factors you mention are inferences.

A risk factor... any risk factor... is an inference. It's an association and
does not necessarily imply any causal relationship. The relationship
demonstrated in this study, between WHR and MI, is purely associative. Are
you implying otherwise?

HG

Hannah Gruen <[email hidden]> wrote:
:> "Roger Zoul" <[email hidden]> wrote in message
:> news:[email hidden]...
:>> Hannah Gruen <[email hidden]> wrote:
:>> :> Look at it this way. Assume that MI is very much associated with
:>> :> the whole insulin resistance/hyperinsulimia/Syndrome X thing.
:>>
:>> That could be tricky.
:>
:> Do you really think there is a lot of controversy over the
:> association between IR/Syndrome X and heart disease/MI?

Well, people now are starting to question to usefulness of the Syndrome X
set of conditions.

:>
:>> The study is saying that WHR is better indicatior than BMI as a risk
:>> factor for HI. All the others factors you mention are inferences.
:>
:> A risk factor... any risk factor... is an inference. It's an
:> association and does not necessarily imply any causal relationship.
:> The relationship demonstrated in this study, between WHR and MI, is
:> purely associative. Are you implying otherwise?

No, I'm referring to your statements about what the study achieved. In
particular:

:> In fact, if you look at it this way, this study appears to be doing
:> little more than reiterating the very strong correlation between
:> heart disease and IR, hyperinsulin, or Syndrome X (whatever you want
:> to call this condition). Not really news.

The study in question didn't track or associate any of these items with MI.

"Roger Zoul" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Hannah Gruen <[email hidden]> wrote:

Quoted message said:

:> Do you really think there is a lot of controversy over the
:> association between IR/Syndrome X and heart disease/MI?

Well, people now are starting to question to usefulness of the Syndrome X
set of conditions.

As well they should, but it still unquestionably represents a substantial
association between insulin and various serious diseases (diabetes, heart
and kidney disease, etc.). But there is also the inflammation factor that
needs to be addressed and that does not appear to necessarily be part of the
"metabolic syndrome" set of factors.

Quoted message said:

:> A risk factor... any risk factor... is an inference. It's an
:> association and does not necessarily imply any causal relationship.
:> The relationship demonstrated in this study, between WHR and MI, is
:> purely associative. Are you implying otherwise?

No, I'm referring to your statements about what the study achieved. In
particular:

:> In fact, if you look at it this way, this study appears to be doing
:> little more than reiterating the very strong correlation between
:> heart disease and IR, hyperinsulin, or Syndrome X (whatever you want
:> to call this condition). Not really news.

Well, duh. Sometimes I think people like to disagree just to keep their
fingers moving. *Obviously* *I* was just speculating about why there might
be a closer association between MI and WHR than between BMI and the other
risk factors, such as smoking, exercise, etc.

Quoted message said:

The study in question didn't track or associate any of these items with
MI.

The study, as I recall, labeled those as risk factors and cited the higher
level of correlation between MI and WHR, compared to BMI or the other
factors. It specifically tracked WHR and BMI, versus MI, but my impression
was that they took into account data re risk from the other factors in
drawing their conclusions. The close association between "metabolic
syndrome" and high WHR, compared to BMI and the other factors, may explain
their findings, IMO.

HG

Hannah Gruen <[email hidden]> wrote:
:> "Roger Zoul" <[email hidden]> wrote in message
:> news:[email hidden]...
:>> Hannah Gruen <[email hidden]> wrote:
:>
:>> :> Do you really think there is a lot of controversy over the
:>> :> association between IR/Syndrome X and heart disease/MI?
:>>
:>> Well, people now are starting to question to usefulness of the
:>> Syndrome X set of conditions.
:>
:> As well they should, but it still unquestionably represents a
:> substantial association between insulin and various serious diseases
:> (diabetes, heart and kidney disease, etc.).

Well, if you start with a vague set of conditions and start to build
assiciations, then you just end up with more confusion.

But there is also the
:> inflammation factor that needs to be addressed and that does not
:> appear to necessarily be part of the "metabolic syndrome" set of
:> factors.
:>
:>> :> A risk factor... any risk factor... is an inference. It's an
:>> :> association and does not necessarily imply any causal
:>> :> relationship.
:>> :> The relationship demonstrated in this study, between WHR and MI,
:>> :> is purely associative. Are you implying otherwise?
:>>
:>> No, I'm referring to your statements about what the study achieved.
:>> In particular:
:>>
:>> :> In fact, if you look at it this way, this study appears to be
:>> :> doing little more than reiterating the very strong correlation
:>> :> between
:>> :> heart disease and IR, hyperinsulin, or Syndrome X (whatever you
:>> :> want
:>> :> to call this condition). Not really news.
:>
:> Well, duh. Sometimes I think people like to disagree just to keep
:> their fingers moving.

I agree. A characteristic of posting on usenet, methinks 🙂

*Obviously* *I* was just speculating about why
:> there might be a closer association between MI and WHR than between
:> BMI and the other risk factors, such as smoking, exercise, etc.
:>

In other parts of your post you were speculating, I had no issue with that.
However, in the paragraph above (the one I quoted), you aren't speculating.
Phrases such as "this study appears to be doing little more than reiterating
.... " and "Not really news" are your opinions, and are drawn from your own
inferences and have nothing to do with the point of the study (see the
"Farewell to BMI" post). As I said before, the study isn't attempting to
address what you're saying it does in that paragraph, even though it might
be valid to draw the conclusions you made (which, are not really news, IMO
🙂 ). I simply think you were being unfair to the authors (and the study)
with that statement. That's my opinion and beyond that, it's not really a
big deal. And I don't hate you because of it, either, 🙂

:>> The study in question didn't track or associate any of these items
:>> with MI.
:>
:> The study, as I recall, labeled those as risk factors and cited the
:> higher level of correlation between MI and WHR, compared to BMI or
:> the other factors. It specifically tracked WHR and BMI, versus MI,
:> but my impression was that they took into account data re risk from
:> the other factors in drawing their conclusions. The close
:> association between "metabolic syndrome" and high WHR, compared to
:> BMI and the other factors, may explain their findings, IMO.

I'm not sure if they really took into account the data re risk from other
factors even though they drew independent associations with MI for them as a
means of comparison. However, I think your last sentence is fair and I
appreciate it, but I'm not sure if even the authors make that association.

"Roger Zoul" <[email hidden]> wrote in message
news:[email hidden]...

Quoted message said:

Well, if you start with a vague set of conditions and start to build
assiciations, then you just end up with more confusion.

Well, I guess we'll just have to disagree on this one, Roger. I see insulin
resistance/hyperinsulimia/Syndrome X/metabolic syndrome as more than a
"vague set of conditions." Further, there seems to be some decent science
that goes beyond mere correlation to link the endocrine issues with the
disease conditions. I personally see the awareness that obesity, diabetes,
heart disease, kidney disease, etc. are all associated with insulin
resistance/hyperinsulimia to be significantly helpful. I'm old enough to
remember when this concept was revolutionary, even among the medical
community.

The problem comes, as usual, when people start seeing this as the *only*
factor involved, thereby ignoring all the zillion other factors that may
influence development of the subject diseases.

Quoted message said:

In other parts of your post you were speculating, I had no issue with
that. However, in the paragraph above (the one I quoted), you aren't
speculating. Phrases such as "this study appears to be doing little more
than reiterating ... " and "Not really news" are your opinions, and are
drawn from your own inferences and have nothing to do with the point of
the study (see the "Farewell to BMI" post). As I said before, the study
isn't attempting to address what you're saying it does in that paragraph,
even though it might be valid to draw the conclusions you made (which, are
not really news, IMO 🙂 ). I simply think you were being unfair to the
authors (and the study) with that statement. That's my opinion and beyond
that, it's not really a big deal. And I don't hate you because of it,
either, 🙂

Actually, *anything* I would say about a scientific study would be fairly
labeled as speculation. However, part of science is looking at data and
associated conclusions, and then speculating about what else that data set
could mean. If you're a scientist in that field, you might go on to write a
letter to the journal editor, or even design your own study to test your
alternative hypothesis. If you're a layperson (like me) it never goes beyond
the speculation stage.

I didn't mean to denigrate the work of the study authors. Like most studies
it's just another brick from the pile of data used to build a new wall. It
will do a good job of convincing the medical community to use WHR rather
than BMI to assess risk for MI, which is a good thing. I do stand by my
opinion that the results were predictable, given the known associations
between WHR and "metabolic syndrome"/hyperinsulimia and between "metabolic
syndrome"/hyperinsulimia and cardiovascular disease. Still, statistical
demonstration of same is a good thing.

HG