COMMENTARY

Further Analysis of INTERHEART: What Do the Data Tell Clinicians?

Arya Sharma, MD

Disclosures

January 19, 2006

In This Article

Where Do We Go From Here?

The original results of INTERHEART provide the worldwide healthcare community with a clear mandate. First, they demonstrate the prevalence of abdominal obesity in all ethnic groups, not just North Americans or even the Western societies, as may have been the prevailing misperception. Second, although BMI has been the most widely used measure of obesity, our analysis of the INTERHEART results has found that, in fact, abdominal obesity -- assessed by such simple measures as waist circumference and waist-to-hip ratio -- serves as a more accurate prognostic measure. In fact, if an increased waist-to-hip ratio were used to predict the risk of CVD, the proportion of humans worldwide classified as obese would increase substantially, especially in the Middle East, South Asia, and in Southeast Asia. Even more important, practitioners can quickly and easily assess patients' future cardiovascular risk, regardless of gender, ethnicity, or concomitant medical history, by simply using a measuring tape. Use of raised waist-to-hip ratios as the index of obesity instead of BMI increases the population-attributable risk (proportion of MIs that could be eliminated if the modifiable risk factors were removed) for MI 3-fold.

Considering the size and diverse ethnic enrollment of INTERHEART, these results should motivate a serious reconsideration of how clinicians approach obesity and the risk of heart attack. Our results suggest a 2-pronged approach. First, they suggest that abdominal obesity is an anatomic parameter that needs to be diagnosed, treated, and reduced. Second, it appears that benefits may also accrue by redistribution of the body's fat stores to the hips or by increasing muscle mass.

Little is known about what specifically reduces abdominal obesity, although overall weight loss probably reduces it. However, if weight loss also leads to a reduction in skeletal muscle mass, this reduction may counteract some of the benefits of weight loss. Implementing weight-loss programs for patients and managing other modifiable risk factors will be integral to reducing future cardiovascular risk.

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