Having extra fat in your abdomen, or even your thighs, can be an indicator of a higher risk of heart attack.

If you’re worried about your cardiac health, you may need to do more than look at a scale.

New research finds that the manner in which your body deposits fat — in the thighs or abdomen resulting in a “pear” or “apple” shape — can greatly affect your cardiac risk.

A study presented at the Radiological Society of North America on Monday examined the body and fat composition of obese men and women and how that was associated with cardiometabolic risk factors.

The researchers, based at the Massachusetts General Hospital and Harvard Medical School, studied 200 people who were either overweight or obese.

Of the 200 studied, 109 were women and 91 were men.

They were all relatively young, with a mean age of 37.

“We wanted to know, between men and women who have the same BMI, whether the fat distribution was different, and also how that translates into cardiometabolic risk factors,” Dr. Miriam Bredella, a lead study author and a radiologist at Massachusetts General Hospital and associate professor of radiology at Harvard Medical School in Boston, told Healthline.

The research team used certain scans to determine body composition and see where these men and women carried fat.

They then looked for early cardiac risk factors like triglyceride levels and insulin resistance.

They found that men carried more visceral fat or “deep belly” fat, resulting in them being more “apple shaped.”

In general, women were more likely to be “pear shaped” or carry superficial fat on their hips and thighs.

The researchers then examined the patients and looked at their cardiometabolic risk profiles.

“We looked at their serum lipids, which were higher in the men,” Bredella said. “They also had higher markers of insulin resistance. So, at the same BMI, men were usually worse off.”

Bredella and her team did find one big surprise when they looked at each group separately.

They found that women who did have more abdominal fat and were “apple shaped” had far more risk factors than the men with the same fat deposition.

“They were much more strongly associated with measures of heart disease or diabetes risk, so for women, each increase of visceral fat or liver fat is much worse or much more dangerous than for men,” Bredella said.

Dr. Rachel Bond, associate director of the Women’s Heart Health Program at Lenox Hill Hospital in New York, said the research can help guide doctors when they assess a patient’s cardiac risk factors.

“We don’t necessarily just have to focus on obesity, but more so where the fat is distributed,” Bond explained.

Bond said that fat carried in the deep belly, called visceral fat, can be far more harmful than the kind of fat that is generally carried on thighs and hips, which is more superficial.

“This subcutaneous fat releases these chemicals that go directly into the heart, and these chemicals can put you at a higher risk for high cholesterol, insulin resistance, and diabetes,” she said.

Bond said cardiologists have already been looking carefully at patients’ waistlines in addition to their weight and body mass index.

However, she said this research can give more clarity about their patients’ cardiac risk factors, especially since it was done in young patients.

“We can now maybe use a tool of where their fat is distributed to see if that is also some form of risk factor that we should focus on,” she said.

Bond said now if a patient came in with a body mass index that wasn’t at an obese level, but they had evidence of visceral abdominal fat, she could bring up the possibility they may be at risk of hurting their heart.

“We may say, ‘OK, you actually are at a heightened risk,’” she explained. “I may suggest that they have early lifestyle changes like exercise, change in their diet, etc.”

She especially was surprised to see that visceral fat in women was more strongly associated with cardiometabolic risk factors.

“Maybe just because women tend to be more pear shaped, the women that are apple shaped may [have] some compelling reason,” for the associated risk factors, she said. They may at “baseline have poor lifestyle choices, such as poor dieting, they don’t exercise.”

However, she said there would need to be more research to explain the reason why these women were at higher risk.