Are you an apple, or a pear?

As part of a large study researchers have shown that the Waist to Hip Ratio (WHR) is probably a more important predictor of heart attack than Body Mass Index (BMI). The WHR is an key measurement that I use in my practice to determine a patient’s risk of future illness and is very simple to do. It is calculated by dividing the measurement around your waist by the measurement around your hips.

When weight is greater around the waist than the hips we often call this an "apple" shape. Those with more weight in the hips are considered to be "pear" shaped. This measure is different from the BMI, which has long been used as the standard tool for measuring overweight and obese persons.

The INTERHEART study compared over 15,000 people at the time of their first heart attack with a similar number of healthy people who had not had a heart attack (The Lancet 2005:366;1640-1649). Researchers used the data to look at both WHR and BMI. This was a study that spanned many cultures, including China, Southeast Asia, Europe, North America, the Middle East, Australia and New Zealand. Across these cultures, as the BMI increased, the risk for heart attack also increased.

When the researchers adjusted for other risk factors this relationship was not as strong, however. By comparing BMI with such things as smoking, abnormal cholesterol profile, high blood pressure, diabetes, stress, a lack of frequent consumption of fruits and vegetables as well as a lack of daily exercise the risk for heart attack was not as strongly predicted by Body Mass Index. When they looked at the same comparisons using the Waist to Hip Ratio the scientists found that the risk of heart attack increased with increasing WHR whether a person had one of the eight INTERHEART risk factors or not.

What this means for you

Weight is important, but it is the distribution of weight that appears to be just as important to preventing heart attack. Check both your Body Mass Index and Waist to Hip Ratio to see where you stand.

First posted: June 2, 2006