Malaga cardiologist stresses the importance of waist measurements in assessing heart attack risks

Health

Dr Gaitán says that a person's waist circumference says much more about their health than their weight does

José Antonio Sau

Around 350,000 people in Malaga province are obese and another 700,000 are overweight, experts say. The condition is associated with more than 220 diseases, including incidents such as heart attacks and strokes.

The scale, however, is no longer the only factor to consider in the fight against excess weight and, above all, cardiovascular risk. Specialists are now paying close attention to what is known as visceral fat. It's no longer just about weight, but also about waist circumference, warns head of the cardiology unit at Hospital Regional Dr Daniel Gaitán.

"Cardiologists are paying increasingly close attention to visceral fat, which accumulates around internal organs and increases the risk of heart attack, stroke, diabetes, and heart failure, even in people with an apparently normal weight," he notes.

What is visceral fat?

"Visceral fat is the fat that accumulates around organs such as the liver, pancreas and intestines. Unlike the fat under the skin, known as subcutaneous fat, visceral fat produces substances that disrupt the body's normal functioning: it contributes to high blood pressure, diabetes, increased cholesterol and the formation of fatty plaques in the arteries," Dr Gaitán says.

This is no longer just a cosmetic issue, but also one of the main factors that increase the risk of suffering a heart attack, stroke or heart failure.

Nearly 60 per cent of Malaga residents suffer from obesity (two out of ten) or are overweight (almost four out of ten), which gives an idea of the magnitude of this public health problem.

Waist circumference is the most useful measurement for estimating excess visceral fat. "In men, cardiovascular risk starts to increase when the waist exceeds 94 centimetres. In women, it starts at 80. When men reach 102 and women 88, the risk is clearly elevated," Dr Gaitán states.

To measure your waist, stand relaxed after a normal exhalation and place a measuring tape at the midpoint between the lower edge of your last rib and the top of your hip bone, keeping it horizontal and without compressing the skin.

This can be done at home and provides more information about the cardiovascular risk than weight or body mass index.

Beyond measuring waist circumference and assessing cardiovascular risk factors such as age, blood pressure, cholesterol, diabetes, smoking, family history and physical activity, there are some tests that can raise suspicion of excess visceral fat.

Elevated triglycerides, low HDL cholesterol, high glucose or glycated hemoglobin or abnormalities related to fatty liver disease are some examples. No single test alone confirms the presence of visceral fat.

Computed tomography (CT) and magnetic resonance imaging (MRI) allow for the quantification of visceral fat. "In cardiology, we are also paying increasing attention to epicardial fat, which surrounds the heart and is associated with a higher risk of coronary artery disease, atrial fibrillation, and heart failure," he notes.

Visceral fat "promotes a state of sustained inflammation, hinders the body's ability to properly use blood sugar, increasing the risk of type 2 diabetes and accelerates the formation of fatty plaques in the arteries".

This partly explains why some people experience a heart attack or a stroke even when other risk factors are reasonably well controlled. For this reason, specialists are increasingly placing importance on abdominal circumference and body composition.

Why is visceral fat increasing among people in Malaga? "The main problem is that we've abandoned very healthy lifestyle habits. We've moved away from the traditional Mediterranean diet, we're less physically active and we spend many hours sitting down. Added to this are constant stress, insufficient sleep and, in some cases, excessive alcohol consumption," the cardiologist says.

Despite everything, the "good news is that visceral fat responds quite quickly when we improve our habits".

"In a few weeks, parameters such as blood sugar, triglycerides and blood pressure begin to improve. In two or three months, the reduction is usually significant. Often, health improves before the patient sees a big difference on the scale," Dr Gaitán says.

Tip: combine aerobic and strength training

The best way to combat it is to "combine aerobic exercise such as brisk walking, cycling or swimming with strength training two or three times a week. What's really important is consistency. It's better to be physically active almost every day than to make a great effort occasionally," the cardiologist says.

It also involves recovering the Mediterranean diet, rich in fruits, vegetables, legumes, fish, nuts and extra virgin olive oil, staying physically active and avoiding a sedentary lifestyle.

Lifestyle changes have been accompanied in recent years by a true medical revolution with the advent of drugs like semaglutide and tirzepatide.

According to Dr Gaitán, these treatments, always under strict medical supervision, not only help with weight loss, but also "reduce visceral fat, decrease inflammation and help improve blood pressure" Various studies demonstrate their ability to reduce the risk of heart attack or stroke.

"Taking care of your waistline is, in reality, the best way to take care of your heart."

Review public health, medical care and clinical news