Lee Kirksey, MD  
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Your Waist Size Predicts Heart Attack Risk

Apr 25, 2009 - 7 comments



Weight gain


Heart Attack










Thyroid problem


Polycystic Ovarian syndrome


insulin resistance

I was reviewing a recent paper on the associations of BMI, waist size and hip to waist ration as predictors of heart attack risk. It turns out that your hip size may have the closest correlation. Currently in the US, 70% of men and 65% of women are obese (BMI) >25.5. As we look to give people simpler ways of self-assessing their heart attack and stroke risk, waist circumference is one simple way to do this. Read on to learn why abdominal fat is a bad thing. As it turns out, those love handles may be cute...but they may also be deadly

According to several recent studies, both waist size and the waist to hip ratio may be better indicators of heart disease risk than the traditional Body Mass Index (BMI).

The American Heart Association (AHA) recommends that people aim for a BMI of between 18.5 and 24.9 however most Americans have a BMI well above this range. Approximately 70% of American men and 60% of American women have a BMI greater than 25 and around 35% of Americans have a BMI greater than 30 (these individuals fall into the obese category). The proportion of Americans with a BMI over 25 has more than doubled over the last 30 years.

The major drawback of BMI is that it does not take into account a persons body composition. An athlete or body builder for example may have little body fat and yet have a BMI well over 25 due to the large amount of muscle they carry.

Waist size on the other hand gives a good indication of the amount of fat a person is carrying, particularly around the stomach area. Abdominal fat is considered an important risk factor for cardiovascular diseases such as coronary heart disease and stroke. Abdominal fat is also a risk factor for diabetes because it leads to a reduction in the body’s response to insulin which results in larger amounts of insulin needing to be secreted by the pancreas to control blood sugar levels. This eventually leads to insulin resistance and the onset of type-2 diabetes.

Most doctors recommend a waist size of under 37 inches (84 cm) for men and 32 inches (81 cm) for women. As of 2008, the average American man has a waist size of around 40 inches, an increase of 5 inches compared to 40 years ago. The average American woman has a waist size of 37 inches, an increase of 7 inches over the last 40 years.

One study, presented at the annual conference of the American College of Cardiology in Atlanta, found that a 14 cm increase in waist size correlated to around a 30% increase in heart disease risk. The data was collected from over 160,000 individuals in 63 countries and represents one of the largest studies on the effects of waist size on heart disease.

A study of post-menopausal women conducted at the Washington University School of Medicine also found that the correlation between waist size and three different heart disease risk factors: insulin sensitivity, HDL-cholesterol, and triglyceride levels was stronger than the correlation between BMI and the three risk factors. The authors of the study concluded that waist circumference was a better measure of heart disease risk than BMI in middle aged and older women.

Recently, it has been suggested that the waist to hip ratio is a better predictor of heart disease than either BMI or waist size alone. The waist to hip ratio is calculated by dividing the circumference of the waist at its smallest point by the circumference of the hips at their widest point. An optimal waist to hip ratio is less than 0.8 in women and 0.9 in men.

A study, published in the American Journal of Epidemiology in 1998, found the waist to hip ratio to be a far better predictor of heart disease than BMI.

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Avatar universal
by geegeelovegod, Apr 26, 2009
you don't have to be overweight to have heart attack it hit's the young and older poeple, small or big

Avatar universal
by angelinamarina, Apr 27, 2009
Thank You for this information.

I have read similar findings.

But if you do not feel that you can do anything about your specific waste ratio this information does not help much.

My problem is that I am 40, F, and have PCOS with IR.  I have what I consider to be a HUGE stomach with loads of abdominal fat, yet thinner arms and legs!  And, what is even more frustrating is that I do a 700 calorie workout 3x a week and try to eat right- 1200 calories, and low glycemic good carbs only.    (although in the past I was a sugar head which is probably why i have the stomach in the first place)

I am 5' 9.5 and I am so tired of trying so hard and not losing weight and I wonder if there is any medication or suggestion for helping to lose or even reduce the abdominal beach ball.

It will NOT go away no matter what I do.  Please do not say situps!  I do tons of them several times a week, backwards, forwards, legs up, everythiung and anything to try to reduce "the bag" as I lovingly call it.   haha

I do not take any drugs except an antidepressant.  In the past I tried metformin but it never really made me lose weight.  Maybe I did not give it enoug of a chance.  It made me crave sugar even more than normal.

Avatar universal
by GrMaLinda, Apr 28, 2009
When I was 40,I also had a beach ball tummy. I didn't change anything in my life except one thing and I actually lost weight as well as my tummy. I went walking around the 1mile track 2times a day(every day). I did what they call power walking. Walk at a good speed(not running),swinging arms with elbows bent,loose fists,then every few minutes, reach out  with each hand like you're trying to grab something and pull it back with gusto. Keep this up for about a minute and repeat this through-out your 2mile walk. I think I lost 10lbs in 2wks & 20lbs in a month.

Avatar universal
by elitehealth, Jun 05, 2009
A really agreeable fact. It might be useful to predict the chances of heart attack better than the previous Body mass index (BMI). I am 54 year old. I gained lot of weight in past 10 years, and I got a distinguishable tummy. I was already having diabetes, but was bit careless as I was mostly concentrating in my business. This carelessness cost me heavily in future. As I was gaining the weight, at the same time, I was unable to balance my cholesterol level. It used to fluctuate heavily. But because of my carelessness, I wasn’t attentive to my health issues, as they were creating hindrance to my work. But at some extreme points, one day I felt some hard beatings on my heart. Suddenly, my heart used to pump vigorously. And there was no point happening that as I was not doing any stressful or physical work. It got worse with time. I was really frightened with the amount of beats it was pumping. It would have been almost double and that also quite hard. I felt dizzy, and suddenly caught a severe headache. And especially, I was having a great amount of pain on my left wrist. I was really helpless at that time. There were no people around, no phone, no one to be called. The only thing that I was able to do was to try to be calm and wait for any help. Somehow, I managed to survive that day. But from that day I was really conscious about the health. That moment was like an alarming signal for something very deadly to happen. I immediately consulted a physician in Los Angeles, where I was staying because of some business work. They suggested me to have some basic cardio test like ECG, etc. I got those test at Elite Health medical office in Los Angeles. It came to me as a shock that I need to have my advance test, as the cardiologist doubted to have a blockage in one of the ventricle. Then they took my advance tests like stress test, Echo cardiogram and MRI. The result was that I was having a 60% blockage in one of the left ventricle, and was in the danger of having heart attack. I was astonished to hear that. Then I got the medications and operations after 3 months. Then I got enrolled in one of the wellness program from same elite health where they used to monitor my health issues round the clock. You can find some more info from www.elitehealth.com/executive_corporate_programs.php. Right now I am quite healthy, taking a lot amount of care regarding the diabetes and heart issues. My weight is also under my control now with the help of reality diet program where the doctors of elite health discuss my current health status and recommend steps for improving my health and dietary habits.

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by spacecadet1963, Jul 28, 2009
Hi i'm wondering if your saying that being bigger is a higher risk for heart factors then why do they not try to put you on meds to surpress your appetite. i am a heart patient on a lot of meds and over weight from having 8 heart caths and having a open bankheart of the left shoulder and being in a body cast for a year and a half. is there a diet besides eating healthier. i have never really ate fried or greasy foods my high cholestrol is heritary. but my question is since i am on all the meds is there a safe diet pill that you can take along with excersing to help surpress your appetite to help aid in losing weight to get to a healthier weight. i have had so many surgeries and i do eat a lot of fruits and vegetables i have changed to a olive butter i do not use salt other than when im cooking i try to get low fat foods but i started reading the contents and it isn't any better then what you were using before in some cases it is worse for you then the orignal product. like fig newtons it is 70 calories for 1 cookie vs 17 cookies of the orignal windmil at 70 calories so how is the low fat fig better for you? both had no saturated fat. please give me some imput thank you for your time.  

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by spacecadet1963, Jul 28, 2009
hi again i have another question for you dr kirksey. I have had 8 heart caths with the placing and replacing of 1 stent i have had 2 major bleed outs. on my second heart cath i had a major bleed out and later in the day i threw up a plastic covering or tubing. i was wondering how this plastic could of gotten into my stomach if it was a covering from one of the instruments and they go through your artery could it have poke through my artery and threw my stomach? i have been in severe pain and haven't been the same since. i have severe pressure to the point i feel as if my head is going to explode off my body and i can't seem to get any air i was told that i have copd and on meds for that and inhalers. I use the inhalers during the attacks that i have and it doesn't help at all i use my nitro it helps after 2-3 i have pain and pressure in my arteries any where you feel for a pulse in my neck,chest,wrist,feet,ect. my question is can you get a build up of scar tissue in the arteries from having so many heart caths? or can a blood clot cause you to have pressure and pain in the arteries. my gp said he thought they may have injured a nerve so i have had 2 nerves blocks with trigger point injections without any relief the doctor that did theses said he didn't think it would help. i have a big knot in my right groin right on the femorl artery and it is very sore. i need help!!!!!!!!!!!!!!! i am short of putting my self out of misery i am tired of taking pain meds i am on perocets i was put on morphine but couldn't take it due to reactions.i have i guess angina i have pain in my chest that goes up my neck in my back. i have been dealing with this for 2 years and getting very depressed and over whelmed. i also died on them 2 times and had to be revived and on one of thses hospital stays i had some type of attack that i was feeling my heart pounding very hard i tried to relax and i fell asleep but was woke up with my heart pounding and beating very fast which they called a code on me my heart was beating 280 bpm do you have any ansewers for me or any suggestions i would greatly apprecaite any help or info that can put me on the right track. Sincerly;Redeena

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by theuniqueldy, Oct 23, 2018
I too read that years ago in a magazine.
As geegeelovegod appears to think,  Dr.Kirksey is 'NOT' saying if your BMI is greater than 25 you will have a heart attack rather your chance is greater.

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