Postmenopausal women may be healthier if more pear-shaped than apple-shaped

Apple-shaped women are three times more likely to have a heart attack or stroke while being pear-shaped in postmenopausal years cuts the risk by almost half, a new study found.

A team of researchers has found that postmenopausal women who have apple-shaped bodies are at a greater risk of developing heart and blood vessel conditions, even with normal and healthy body mass index (BMI) than those who have pear-shaped bodies.

Image Credit: Aleksandar Todorovic / Shutterstock
Image Credit: Aleksandar Todorovic / Shutterstock

The study, which was published in the European Heart Journal, found that women of a healthy weight with the highest risk of heart disease and stroke had the most belly fat and least hip and thigh fat. This means that apple-shaped women had more fat around the belly and they had a three-fold increased cardiovascular disease risk, compared to those with more fat in the hip and thigh areas.

To discover their findings, the researchers looked at where fat is stored, and linked it to the risk of cardiovascular disease in postmenopausal women who have normal BMI. The normal BMI is 18.5 to less than 25 kg/m2.

The researchers at the Albert Einstein College of Medicine in New York analyzed the body fat distribution of 2,863 postmenopausal women over an 18-year period. The women were part of the Women’s Health Initiative in the United States, between the period of 1993 to 1998, and was followed up in 2017.

Pear-shaped better than apple-shaped

The team ranked the participants in order if they were pear-shaped or apple-shaped. Pear-shaped women had more fat stored in the hips and legs, while apple-shaped women had more belly fat. The top 25 percent of women with apple-shaped bodies were twice as likely to have heart disease and stroke. On the other hand, the top 25 percent of women with pear-shaped bodies were 40 percent less likely to develop heart disease or stroke.

The researchers also found that the greatest risk of cardiovascular disease occurred in women who had the highest fat percentage around the middle or abdomen, and the lowest leg fat percentage, giving them a three-fold increased risk than to women with more fat in the legs and less fat around the belly.

Bigger waist circumference, compared to the hip and leg fat content, has been linked to an increased risk of CVD mortality in other populations even with normal BMI.

"Our findings suggest that postmenopausal women, despite having normal weight, could have varying risk of cardiovascular disease because of different fat distributions around either their middle or their legs. In addition to overall body weight control, people may also need to pay attention to their regional body fat, even those who have a healthy body weight and normal BMI,” Dr Qibin Qi, an associate professor at the Albert Einstein College of Medicine, New York (USA), said in a statement. "However, it is important to note that participants of our study were postmenopausal women who had relatively higher fat mass in both their trunk and leg regions. Whether the pattern of the associations could be generalizable to younger women and to men who had relatively lower regional body fat remains unknown,” Dr. Qi added.

Body fat distribution better than just BMI

To measure fat mass, the researchers used a Dual-energy X-ray Absorptiometry (DXA) scan, a machine that can measure bone, muscle, and fat density. But, they noted that the scan is still too early to use when screening normal weight populations. They recommend using an easier, more accessible, and cheaper means, which is the waist and hip ratio.

The study’s findings highlight the need for anthropometric measurements rather than weight, in determining the risk of cardiovascular disease. In fact, measuring the waist and hip circumference is a better way to provide information than just computing for the BMI, which involves only the weight and height of an individual.

“In summary, our findings suggest that normal BMI postmenopausal women who have higher trunk fat or lower leg fat are at elevated risk of CVD. These findings highlight the importance of fat distribution beyond overall fat mass in the development of CVD,” the researchers said in the study.

However, the researchers reiterate that the findings do not show that the site where body fat is stores can cause the difference in risk of CVD like heart disease and stroke, it’s only associated to these conditions.

The World Health Organization (WHO) reports that in 2016 alone, more than 1.9 billion people who are 18 years old and above are overweight. Among these, more than 650 million are obese. Between 1975 and 2016, the prevalence of obesity across the globe tripled.

Journal reference:

Chen, G., Arthur, R., Iyengar, N., Kamensky, V., Xue, X., Wassertheil-Smoller, S., Allison, M., Shadyab, A., Wild, R., Sun, Y., Banack, H., Chai, J., Wactawski-Wende, J., Manson, J., Stefanick, A., Dannenberg, A, Rohan T., and Qi, Q. (2019). Association between regional body fat and cardiovascular disease risk among postmenopausal women with normal body mass index. European Heart Journal. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehz391/5524773

Angela Betsaida B. Laguipo

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Angela Betsaida B. Laguipo

Angela is a nurse by profession and a writer by heart. She graduated with honors (Cum Laude) for her Bachelor of Nursing degree at the University of Baguio, Philippines. She recently completed a Master's Degree where she specialized in Maternal and Child Nursing and is now working as a clinical instructor and educator in the School of Nursing at the University of Baguio.

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