Health Article: The Waist-Heart Connection

Carrying excess weight around your middle could have a profound impact on your heart.

There is an important medical condition so obvious that I can diagnose it without performing a single diagnostic test. I can spot it the instant a patient walks into my office. It's so common that I see it everywhere — at malls, in restaurants, on the golf course, and strolling down the street. It has reached epidemic proportions in the United States. I'm sure you've seen it, too, among your family and friends, and maybe when you look in the mirror.
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The ailment has many names, including metabolic syndrome, insulin resistance, Syndrome X, and the name I will use, prediabetes. Why is it so easy to diagnose? There's one clue that's a dead giveaway: It's your waistline. One of my colleagues says that when a patient's belly is the first body part to enter his office, the diagnosis is made. If you have gained weight in middle age and most of it is in your belly, you are likely part of the American epidemic of prediabetes. And if you don't start eating better and exercising, full-blown diabetes will almost certainly be in your future.
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Why would a cardiologist be so concerned with your waistline? The reason has less to do with how you look on the outside than it does with how you look on the inside. I'm worried about what prediabetes and diabetes are doing to your arteries. Both conditions can injure the lining of your vessels and accelerate the production of plaque, greatly increasing your risk of having a heart attack or stroke.
After a meal, it is the job of insulin to help transport fats as well as sugar from the blood into the tissues. As you develop insulin resistance, fats accumulate in your bloodstream and hang around much longer than usual. During this time, changes in your blood fats occur — your LDL particles and your HDL particles become smaller and your total HDL is reduced. These changes favor the movement of cholesterol from your bloodstream into your artery walls. The smaller and denser the LDLs are, the more likely they are to move into your vessel walls. And the smaller and denser the HDLs are, the less efficient they are at removing the cholesterol from those vessel walls. These changes are also associated with high blood fat levels measured in the form of triglycerides. The fact that these fats are in your bloodstream longer also favors their accumulation in the vessel walls.
So, if you have gained predominantly belly fat as an adult and there is diabetes in your family (even if it occurred in a parent or grandparent late in life), you probably are insulin resistant and have prediabetes. The diagnosis of prediabetes is made if you meet three of the five following criteria:

• Central obesity: A waist circumference of greater than 40 inches for men and 35 inches for women
• Elevated triglycerides: Greater than or equal to 150 mg/dL
• Low total HDL: Less than or equal to 40 mg/dL for men and less than or equal to 50 mg/dL for women
• Elevated blood pressure: Systolic blood pressure of greater than or equal to 130 mm Hg and diastolic blood pressure of greater than or equal to 85 mm Hg
• Elevated fasting glucose: Greater than or equal to 100 mg/dL