Share on Pinterest
Experts say it’s important to lose weight, eat healthy, and exercise after an initial heart attack. Getty Images
  • Researchers say belly fat is a major risk factor for repeat heart attacks, even more than BMI readings.
  • Experts say abdominal obesity can increase a person’s risk for a second heart attack even if they are taking proper medication and following other medical advice.
  • They note that a first attack can cause inflammation, stress, and changes in arteries that can lead to a second attack.

Survivors of heart attack who have excess fat around their abdomen are at an increased risk for another heart attack.

Prior research has established that abdominal obesity, or belly fat, is a risk factor for having a first heart attack, but now researchers in Sweden say they have found an association between abdominal obesity and repeat heart attacks.

“In our study, patients with increasing levels of abdominal obesity still had a raised risk for recurrent events despite being on therapies that lower traditional risk factors connected with abdominal obesity — such as anti-hypertensives, diabetes medication, and lipid lowering drugs,” Dr. Hanieh Mohammadi, author of the study and researcher at the Karolinska Institute in Stockholm, said in a press release.

“Abdominal obesity not only increases your risk for a first heart attack or stroke but also the risk for recurrent events after the first misfortune,” she said. “Maintaining a healthy waist circumference is important for preventing future heart attacks and strokes regardless of how many drugs you may be taking or how healthy your blood tests are.”

Mohammadi’s research is the largest ever study undertaken on the topic.

It followed more than 22,000 heart attack survivors after their first heart attack.

Study participants were followed for a median of 3.8 years.

The researchers examined the link between abdominal obesity as determined by waist circumference and the risk for secondary cardiovascular events such as a heart attack.

Most of the 22,000 participants had abdominal obesity. Almost 80 percent of the men followed had a waist circumference over 94 centimeters (37 inches) and 90 percent of the women had a waist circumference of 80 centimeters (31 inches) or more.

The researchers found that increasing abdominal obesity was associated with heart attacks and strokes, regardless of other factors such as smoking and diabetes, and despite the participants undertaking prevention treatments to avoid a secondary cardiac event.

The researchers said that waist circumference was a more important marker of a recurring cardiovascular event than overall obesity.

Experts say using waist measurement can be a more effective means of determining risk for cardiovascular events than other factors such as body mass index (BMI) readings.

“The most important measurements are waist circumference and waist-to-hip ratio,” Dr. Megan Kamath, a cardiologist at UCLA Health in California, told Healthline. “Waist measurement and waist-to-hip ratio measurements have been shown to be quite useful in predicting risk of heart attacks. Waist measurements have been shown to be more useful in predicting cardiovascular risk than BMI as they are specific to abdominal fat.”

Every 37 seconds, a person in the United States dies from cardiovascular disease. Heart disease is the leading cause of death for both men and women in most ethnic and racial groups in the United States.

Every 40 seconds, someone in the United States has a heart attack. That amounts to around 805,000 Americans having a heart attack every year. Of those, 605,000 are a first heart attack.

“The chance of getting a second heart attack from a first attack is 1 in 5… 20 percent of patients can have a second heart attack after a first one… despite taking significant medication to reduce the risk,” Dr. Sanjiv Patel, interventional cardiologist at MemorialCare Heart and Vascular Institute at Orange Coast Medical Center in California, told Healthline.

Among the risk factors for a second heart attack is having a first heart attack.

“Just by having the first heart attack, the risk of second heart attack is there. The act of having a heart attack itself is a significant event for the body… a lot of inflammation, a lot of stress, and that can destabilize other blocked areas in the arteries of the heart, which can lay a foundation for the future heart attack,” Patel said.

Dr. Nieca Goldberg, medical director of the NYU Women’s Heart Program in New York, says the findings of the Swedish study make sense.

“I am not surprised by the increased risk for second heart attack. Abdominal obesity is associated with elevated blood sugar, hypertension, and the increase in inflammatory factors. Abdominal obesity is riskier than generalized obesity,” she told Healthline.

In the study, people with abdominal obesity were still at an increased risk for a second heart attack even if they were on treatments that would lower some of the risks associated with abdominal obesity.

Patel says this is important for people to understand.

“It is very eye-opening… in the sense that despite taking the medications, obviously it decreases the chance of second heart attack, but the effect of the abdominal obesity affected you more. So it tells you that just taking medication after the first heart attack isn’t enough,” he said.

Patel notes it is an important reminder to heart attack survivors that as well as taking their prescribed medications, they must also make positive lifestyle changes.

“You still need to eat better, you still need to exercise, you still need to lose weight. If you have abdominal obesity you’ve got to get rid of that or reduce it, because medication by itself is not the answer. You’ve got to do both,” he said.

“Those basics must be done, otherwise you will lose some of the gains that you get from medication,” he said.