HARVARD GAZETTE ARCHIVES

Women's Shapes Linked to Heart Disease

By William J. Cromie
Gazette Staff

Kathryn Rexrode of the Harvard Medical School and Brigham and Women's Hospital in Boston.

Pear-shaped women are at less risk of heart disease than those with an apple shape, according to a new Harvard study.

Other studies have established obesity as a risk factor for heart disease in both men and women. This research concludes that for women over age 40 it's not just being too fat that's unhealthy, it's also how that fat is distributed.

Middle-aged and older women with a waist measurement of 30 inches or more have at least twice the risk of heart disease than slimmer females. If waist size goes to 38 inches, the risk triples compared to a waistline of 28 inches or less. But whether overweight or not, too much fat around the waist is a danger signal.

"Women who are apple-shaped, that is, with a high waist-to-hip ratio, are at increased risk for coronary heart disease compared to pear-shaped women, who have low waist-to-hip ratios," according to Kathryn Rexrode of the Harvard Medical School and Brigham and Women's Hospital in Boston.

In 1986 Rexrode and her colleagues sent questionnaires that asked about waist and hip measurements to 44,702 nurses aged 40 to 65. They followed these women for eight years, during which 251 suffered heart attacks and 69 died of heart disease. Analysis of the information led to the conclusion that females with a ratio of 0.88 or higher are more than three times as likely to have heart disease than women with a ratio of 0.72 or less.

The ratio is determined by dividing waistline circumference by hip circumference. Women at lowest risk, those with a ratio of 0.72 or less, have waistlines 72 percent less than their hip circumference. Those at greatest risk have waists 88 percent or more of their hip measurement. A woman with a ratio of 0.72 and a waistline of 28 inches would have 39-inch hips (divide waist size by the ratio). One with a 30-inch waist and a 0.88 ratio would have 34-inch hips.

The researchers published their results yesterday in the Journal of the American Medical Association.

An earlier Harvard study of men 40 years and older concluded that those with a ratio of 0.98 or higher (shaped more like a potato) increased their risk of heart disease to about 40 percent. That compares with a risk of more than 300 percent for women with a ratio of 0.88 and higher.

"The risk of coronary heart disease in those with high waist-hip ratios is, therefore, less potent in men," Rexrode notes.

Independent of waist-to-hip ratio, healthy women and men need to watch their body-mass index, or BMI. Anyone with a BMI of 25 or more is considered overweight and at increased risk for heart disease.

To determine BMI, multiply your weight by 703 and divide it by your height in inches squared. A 5-foot-4-inch (64 inches) woman weighing 146 pounds has a BMI of 25. Losing six pounds would reduce her BMI to 24. A six-foot man with a BMI of 24 would have a weight of between 175 and 180 pounds.

A BMI below 25, Rexrode notes, "is clearly one of the most effective means of reducing risk of heart disease. And any effort to reduce total body fat lowers waist-to-hip ratios and waist circumference. Our data suggests that simple circumference measurements will assist in identifying women at increased risk of coronary heart disease."