I am definitely not any kind of expert in this area. If you are well versed and feel anything I have written is at odds with the correct literature please let me know.
My interest in writing this piece came from a curiousity as to what the link was between abdominal obesity and shortened life span.
I guess I always wondered what the contributing factors for something sudden like heart attack and stroke were as well, as I think we all have a family member or friend who has been touched by this.
Was the person overweight? Did the person smoke, drink or have a poor diet? Was the person active? Was it all of the above? Was it genetic?
I have a very, very healthy fear of death. A big part of my interest in fitness is me trying to stack the odds in my favour of a long life, and one in which my quality of life is good also.
I decided to have a look at what the risk factors were for heart attacks and stroke, and how strong the connection was with obesity. One of the main areas that crops up is something called ‘metabolic syndrome‘ (MS).
A lot of this information is new to me, so I hope to present it in a way that is easy to understand…this is for my benefit as much as it is for yours.
What is cardiovascular disease (CVD)?
Cardiovascular disease, or heart disease, is a general term for conditions affecting the heart and blood vessels, with the most common being a heart attack or stroke.
A heart attack occurs when blood is prevented from travelling to the heart itself, a stroke is when blood is prevented from reaching the brain.
The following statistic is from the Irish Heart Disease Awareness website (http://www.ihda.ie/).
‘1 in 4 people will die from heart disease or stroke in Ireland. This equates to approximately 10,000 people in Ireland who will die each year from a heart attack, stroke or other associated conditions.
This makes heart disease the biggest killer in Ireland.
Heart disease is progressive and worsens over time. A heart attack is often a failure of prevention that has been building up for many years’.
I would highly recommended visiting the site and viewing the video which accompanies the ‘What is calcification?’ piece.
It gives a quick overview as to what happens inside the body when heart disease occurs, and it explains how easy and non-invasive it is to get tested.
There is also a list of test locations at the following page;
If you look for risk factors associated with cardiovascular disease you will find a cluster labelled ‘metabolic syndrome‘.
What is metabolic syndrome?
Metabolic syndrome is a cluster of risk factors associated with developing cardiovascular disease. The more risk factors you have, the more likely you are to suffer from CVD.
According to the American Heart Association, 1 in 6 Americans have MS. (1)
What are the risk factors?
The components of metabolic syndrome (2).
1 – Abdominal obesity (this is the form of obesity most strongly associated with metabolic syndrome. It presents clinically as increased waist circumference).
2 – Poor cholesterol scoring (increased LDL, decreased HDL, elevated triglycerides in the blood)
3 – Hypertension (elevated blood pressure).
4 – Insulin resistance (IR) (diabetes – this is generally, but not always, associated with obesity).
5 – Proinflammatory state.
6 – Prothrombotic state.
Other contributing factors include; advancing age, physical inactivity and smoking.
Obesity appears to be the main culprit and it causes a follow on of all the other main factors. In other words, metabolic syndrome is a cluster of complications caused by obesity.
Obesity is also heavily correlated with insulin resistance or diabetes.
It’s worth noting however, ‘diabetes can occur across a wide range of BMI levels in some populations, e.g South Asians who can manifest IR with only a mild-to-moderate overweight’, so it’s important to note that there are no certainties.
‘When diabetes becomes clinically apparent, CVD risk rises sharply. Beyond obesity and insulin resistance, each risk factor is subject to it’s own regulation through both genetic and acquired factors’.
In other words, there’s a whole lot of other stuff going on that cannot be pinpointed BUT obesity and diabetes should be avoided at all costs through making informed lifestyle choices.
Obesity and diabetes/insulin resistance (IR).
‘Obesity has been more precisely defined by the National Institutes of Health (the NIH) as a BMI of 30 and above.
The BMI (body mass index), a key index for relating body weight to height, is a person’s weight in kilograms (kg) divided by their height in meters (m) squared. Since the BMI describes the body weight relative to height, it correlates strongly (in adults) with the total body fat content.
Some very muscular people may have a high BMI without undue health risks’. (3)
People criticise BMI as a measure. If your BMI is high, you’re carrying some amount of body fat around your mid-section and you do not exercise, I think it’s fair to say it can be viewed as a good indicator of ‘there may be a problem here’.
If you add in a blood test I think a clear picture will start to emerge either way.
‘Diabetes is a long-term condition that causes high blood sugar levels. All forms of diabetes increase the risk of long-term complications which relate to damage to blood vessels. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes. (4)
- Type 1 Diabetes – the body does not produce insulin. Approximately 10% of all diabetes cases are type 1. In type 1 diabetes, the immune system mistakenly attacks the insulin-producing pancreatic beta cells.
- Type 2 Diabetes – the body does not produce enough insulin for proper function. Approximately 90% of all cases of diabetes worldwide are of this type. Type 2 often results from obesity and lifestyle and dietary factors, as well as medications and other issues.
- Gestational Diabetes – this type affects females during pregnancy. Some women have very high levels of glucose in their blood, and their bodies are unable to produce enough insulin to transport all of the glucose into their cells, resulting in progressively rising levels of glucose. Diagnosis of gestational diabetes is made during pregnancy
The combination of obesity/diabetes has a huge negative impact on health.
Back to assessing the MS risk factors.
We can’t do anything about the ageing process, but we can definitely take control of activity levels, general health based lifestyle choices and nutrition, which will affect body weight. We’ve seen the poor outlook for obesity/IR, so it’s important to keep weight in check.
The defining level of risk factor for abdominal obesity presented in the study is as follows (2);
Male >40 inch waist circumference.
Female >35 inch waist circumference.
‘Waist circumference is highly correlated with metabolic syndrome, more so than elevated BMI. Some male patients can develop multiple risk factors when waist circumference is only marginally increased due to a strong genetic component – 37 to 39 inch waist circumference‘.
Obesity is the primary target of intervention for MS. Weight loss and an increase in activity helps lower serum cholesterol and triglycerides, raises HDL cholesterol, lowers blood pressure and blood glucose levels and reduces the chances of insulin resistance.’
There is full agreement that therapeutic lifestyle change, with emphasis on weight reduction, constitutes first-line therapy for metabolic syndrome’. (2)
What can you take from this?
Steer clear from becoming obese and/or the onset of diabetes, this in turn affects any chance of metabolic syndrome occuring, which in turn will minimise risk of cardiovascular disease (your genetic risk factor may vary).
It’s worth noting that there is a very, very poor success rate ( around 10-12%) of obese individuals losing weight and keeping it off. You can view this from a health perspective, a quality of movement perspective, or a ‘how happy are you with how you look’ perspective.
You just don’t want to go there if any of that stuff matters to you.
What is my advice from looking into this subject?
It’s not that difficult to measure your waist. It will be obvious visually if you are struggling with fat levels around your mid section.
It’s not that difficult to organise a blood test with your GP.
With the information provided from the Irish Heart Disease Awareness website I would argue it’s not that difficult to organise a test to establish the level of calcification in your heart if you felt you were at risk.
There is a financial outlay to this, but what price do you put on your health?
I feel very strongly about this point – people spend a lot of money on stupid shit.
Your very first priority should always, ALWAYS be to make sure you are in good health. As the old saying goes ‘your health is your wealth’.
People are also very poor at analysing and being realistic about their own current lifestyle choices and the nutritional value of their diet.
You also need to keep in mind that nature plays a part too – you can be genetically predisposed to certain conditions, and that’s something that’s much harder to identify.
While nature may have played it’s hand, you still have an incredible amount of influence through how things go via nurture.
Observationally, I have seen people people suffer from sudden acute illness caused by poor lifestyle choices who recover, yet they DO NOT change.
Long formed habits can be EXTREMELY difficult to break for certain individuals, even when their life seems to be at stake.
If you think you are at risk consult your GP. Even if you don’t think you’re at risk you should still check on things.
I’m 34 and I get my bloods done every year just to make sure everything is as it should be. I don’t carry any abdominal fat, but that is simply one of several risk factors, and even then you can never, ever be certain as to what’s going on in the body.
Chances are everything is okay, but I prefer to know. We are privileged to live in a time where this information and research is available at the click of a button.
Use it to extend your life.
I hope the information presented has helped you in some way, if you’ve got any feedback please let me know.
(2) Definition of Metabolic Syndrome? (Grundy et al 2004)