Among Diabetics, Waist Circumference Matters More Than BMI, Weight

Carrying weight around the midsection was associated with dysfunction of the left ventricle, according to a study presented at the American College of Cardiology.

Among persons with diabetes, one’s waist circumference is a stronger predictor of future heart disease than weight or body mass index.

That’s what researchers with Intermountain Medical Center and Johns Hopkins University reported during the 65th Scientific Session of the American College of Cardiology, which took place April 2-4, 2016, in Chicago, Illinois.

The well-known adage that it’s better to be shaped like a “pear,” with weight around the hips, than an “apple,” with belly fat, appears to be true among both persons with type 1 or type 2 diabetes who have not displayed any signs of heart disease.

Carrying weight around the middle has been linked to metabolic syndrome, a constellation of indicators that include high blood pressure, high blood sugar levels and high cholesterol, as well as coronary artery disease. But this new study of 200 men and women also found that the “apple” shape—or abdominal obesity—is a strong a predictor of left ventricular dysfunction.

These new results expand on an earlier study called faCTor-64, which found that the greater a person’s BMI, the great their risk for heart disease. This study enrolled patients with diabetes who had risk factors for heart disease but had not yet shown symptoms. These participants completed randomized screening for coronary artery disease; based on results, they were either given recommendations for lifestyle changes or standard diabetes care.

Researchers tracked the group for future heart events. The 200 patients who were screened also had echocardiography to assess left ventricular function—this is the area that pumps oxygen-rich blood through the rest of the body. Any dysfunction here causes blood to back up and leads to cardiac arrest.

While obesity generally increase strain on the heart, the researchers found that carrying weight around the midsection was a strong predictor of future dysfunction in the left ventricle—more so that overall weight or BMI.

“It will be important to see if these patients are indeed at risk of developing heart failure or coronary artery disease in the future,” said Boaz D. Rosen, MD, of Johns Hopkins, principal investigator, who said more studies are needed to verify findings.


Rosen BD, Sharma R, Horton KD, et al. Waist circumference is a strong predictor of regional left ventricular dysfunction in asymptomatic diabetic patients: the factor 64 study. Presented at the 65th Scientific Session of the American College of Cardiology, Chicago, Illinois. April 2, 2016. Abstract 1111-265.

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