Published: 21-01-2020 06:00 | Updated: 23-01-2020 08:58

Belly fat linked to increased risk for recurrent heart attacks

Abdominal obesity not only increases the risk for a first heart attack or stroke, but also the risk for recurrent atherosclerotic cardiovascular disease, according to a study by researchers at Karolinska Institutet published in the European Journal of Preventive Cardiology.

Prior studies have shown that abdominal obesity is an important risk factor for having a first heart attack as it is closely linked with conditions that accelerate the atherosclerotic process, including increased blood pressure, high blood sugar, insulin resistance and raised blood lipid levels. However, it has been unknown if there is an association between abdominal obesity and recurrent cardiovascular events.

For the study, the researchers followed more than 22,000 patients after their first heart attack and investigated the relation between abdominal obesity (waist circumference 94 cm or above for men and 80 cm or above for women) and the risk for recurrent fatal and non-fatal heart attacks and strokes. Patients were recruited from the nationwide SWEDEHEART registry and followed for a median of 3.8 years.

May be other negative mechanisms

78 per cent of the men and 90 per cent of the women had abdominal obesity. Increasing grades of abdominal obesity was independently associated with increased risk for recurrent heart attacks and strokes, regardless of other risk factors or treatments to prevent second events (such as anti-hypertensives, antiplatelets, anticoagulants and lipid lowering drugs).

“Our results suggest that there may be other negative mechanisms associated with abdominal obesity that are independent of traditional risk factors and that remain unrecognised,” says Hanieh Mohammadi, physician at Karolinska University Hospital and first author of the study.

Waist circumference was a more important marker of recurrent events than overall obesity. The authors recommend using it in clinical settings to identify first-time heart attack patients at increased risk of recurrent events.

A healthy diet can lower the risk

Per Svensson. Photo: Ingela Wåhlstrand/Karolinska University Hospital

“A healthy diet and regular physical activity can help maintain a healthy waist circumference, lowering the risk for future heart attacks and strokes,” says Per Svensson, consultant and docent at the Department of Clinical Science and Education (Stockholm South General Hospital), Karolinska Institutet, who led the study.

The relationship between waist circumference and recurrent events was stronger and more linear in men. However, there were three times as many men in the study compared to women, contributing to less statistical power in the female group.

The study was supported by grants from Familjen Janne Elgqvists Stiftelse and Stiftelsen Serafimerlasarettet. Co-author Johan Sundström is on the advisory board of Itrim, a Swedish weight loss company.

This news article is based on a press release from the European Society of Cardiology (ESC).


“Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction”. Hanieh Mohammadi, Joel Ohm, Andrea Discacciati, Johan Sundström, Kristina Hambraeus, Tomas Jernberg and Per Svensson. European Journal of Preventive Cardiology, online 21 January 2020, doi:10.1177/2047487319898019.