Heart Risk – BMI Not Useful

Or as Reuters put it: “[T]he best predictors of future heart risk are measures of blood pressure, cholesterol and history of diabetes.”

According to a paper in The Lancet:

BMI, waist circumference, and waist-to-hip ratio, whether assessed singly or in combination, do not importantly improve cardiovascular disease risk prediction in people in developed countries when additional information is available for systolic blood pressure, history of diabetes, and lipids.

Researchers looked at height, weight, hip, waist, blood pressure, cholesterol and other data from more than 220,000 adults — who had no previous history of heart disease – and tracked them over time to see who had heart attacks.   Once they controlled for age, sex, smoking, baseline systolic blood pressure, history of diabetes, and total and HDL cholesterol, they found that BMI or waist-to-hip ratio didn’t add much information.

The headlines and articles focus on how this refutes the notion that “pear-shaped” fat people are at less risk of heart disease than “apple-shaped”.    I wonder if this implies that thin people who have high cholesterol, high blood pressure or diabetes (all of which can be affected by family history) might have their risk factors ignored because they’re thin.

13 thoughts on “Heart Risk – BMI Not Useful

  1. Off topic so please forgive:

    Not sure why, today, but I feel compelled to stop by here and say thank you for writing this blog and for sharing your views, and those of others, with so much compassion and empathy.

    Words are inadequate to express how much it means to me–to know that your blog exists, and that your voice is heard.

  2. OMG, yes. I needed to hear this today. I’m so tired of defending my health. And I shouldn’t have to. Because even if I wasn’t healthy, it isn’t as though skinny people don’t get sick. I had a conversation with a very thin friend once, where I was talking about how difficult it is for a fat person to get decent medical care. She told me that she had cancer–and it went undiagnosed for a long time because she appears to be healthy.

    • I had a conversation with a very thin friend once, where I was talking about how difficult it is for a fat person to get decent medical care. She told me that she had cancer–and it went undiagnosed for a long time because she appears to be healthy.

      Argh. People keep wanting “healthy” to be obvious, and it isn’t.

  3. Pingback: Heart Risk – BMI Not Useful (via Living ~400lbs) « Tracy Brown, RD, LD/N

  4. For your question about thin people being at risk with high cholesterol, high blood pressure or diabetes, I actually subscribes to the Lancet and looked at the full paper to get a look at the hard data, and this is what I found: They included only people with a BMI of 20 kg/m2 or higher. This means that they were examining the risk associated with higher BMI’s in comparison to people with ‘normal’ BMI’s. They explicitly left out BMI’s less than 20, because of “non-linear associations” (read: increased risk for those in the ‘under-weight’ category). Looking closer at their tables for risk, they measure the increase in risk by every 4.56 points BMI, 12.6 cm waist circumference increase, and every 0.083 higher hip-to-waist ratio. […]

  5. Just to clarify my answer to your question: Yes, if the physician is using adipose measurements to determine cardiovascular risk, they will likely misdiagnose someone who is fat as well as overlook someone who is thin and showing other symptoms. If the physician uses a combination of adipose measurements and intermediate risk factors such as high blood pressure, blood lipids, and diabetes, they might exaggerate the risk for someone who is fat and down play the risk for someone who is thin. If they judge by intermediate risk factors alone, they will have the best results.

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