Excess waist fat is common in many people with a high risk of heart disease and stroke, according to a recent European study.

The study, called EUROASPIRE V, is a survey of cardiovascular disease prevention and diabetes. It forms part of a European Society of Cardiology research program.

The findings featured recently at the World Congress of Cardiology & Cardiovascular Health in Dubai in the United Arab Emirates.

They revealed that nearly two-thirds of individuals at high risk of cardiovascular disease had excess abdominal fat.

The results also showed that:

• Only 47% of those taking drugs to reduce high blood pressure were achieving a target of under 140/90 millimeters of mercury, or under 140/85 for those who reported having diabetes.

• Among individuals using lipid-lowering medication, only 43% had reached the low-density lipoprotein (LDL) cholesterol target of under 2.5 millimoles per liter.

• Many who were not in receipt of treatment for high blood pressure and high LDL cholesterol had those conditions.

• Only 65% of individuals receiving treatment for type 2 diabetes had attained the target blood sugar of under 7.0% glycated hemoglobin (HbA1c).

"The survey," says Kornelia Kotseva, chair of the EUROASPIRE Steering Committee and a professor at Imperial College London in the UK, "shows that large proportions of individuals at high risk of cardiovascular disease have unhealthy lifestyle habits and uncontrolled blood pressure, lipids, and diabetes."

Individuals with high heart risk

The recent study focuses on "apparently healthy individuals in primary care at high risk of developing cardiovascular disease, including those with diabetes."

Altogether, 78 primary care practices from 16, mainly European, countries took part in the research, which took place during 2017–2018.

They recruited individuals who were under 80 years of age and had no history of coronary artery disease or other conditions arising from atherosclerosis.

However, assessments had shown that they were at high risk of developing cardiovascular disease due to one or more of the following: high blood pressure, high cholesterol, or diabetes.

The researchers used medical records to identify those eligible for the study and invited them for an interview and clinical exam.

The interviewers asked questions about diet, exercise, smoking, and other lifestyle factors.

The analysis included a total of 2,759 people. Of these:

• 64% had central obesity, which is a measure of excess abdominal fat.

• 37% were in the overweight category for body mass index (25.0–29.9 kilograms per square meter).

• 18% were current smokers.

• 36% were achieving the typical guideline physical activity level of at least 30 minutes on 5 days of the week.

The researchers defined central obesity as having a waist size of at least 88 centimeters (34.7 inches) for women and at least 102 centimeters (40.2 inches) for men.

'GPs need to be more proactive'

Prof. Kotseva urges primary care practitioners to be proactive about looking for cardiovascular risk factors.

They need to probe beyond the risk factors that they are already aware of and "always investigate smoking, obesity, unhealthy diet, physical inactivity, blood pressure, cholesterol, and diabetes," she argues.

Individuals often don't realize that they should be receiving treatment. They may visit their doctor for diabetes care and not know that they also have high blood pressure.

"In our study, many participants with high blood pressure and cholesterol were not being treated," notes Prof. Kotseva.

She suggests that the findings highlight a need for more investment and policy that focuses on prevention.

The recent news follows that of earlier research that featured at the European Society of Cardiology Congress in April 2018 in Ljubljana, Slovenia.

In that study, researchers from the Mayo Clinic in Rochester, MN concluded that excess belly fat is "bad for the heart," even in individuals whose BMI is in the normal range.

They advised doctors not to assume that having normal BMI means that there is no heart-related issue in an otherwise healthy individual.

A BMI in the normal range does not necessarily indicate normal fat distribution. It is important to measure central obesity as well, to get a better picture of heart risk.

"These data make it clear that more efforts must be made to improve cardiovascular prevention in people at high risk of cardiovascular disease."

—Prof. Kornelia Kotseva