Neck Size a Measure of Heart Risk

Doctors have long measured fat in the gut -- visceral adipose tissue, to use the formal name -- to help assess the risk of cardiovascular disease. But fat in the neck is closely associated with the known factors for heart trouble, such as cholesterol levels and diabetes, said a report using data on 3,320 offspring of the study's original participants.

"Neck circumference was associated with cardiometabolic risk factors, even after adjustment for visceral adipose tissue," the researchers wrote in the report, which was to be presented last week at the American Heart Association’s Cardiovascular Disease Epidemiology and Prevention annual conference in Palm Harbor, Fla.

The standard ways to assess obesity is to measure the waistline and determine body-mass index. But neck fatness could add to the risk assessment. 

“Upper-body subcutaneous adipose tissue and visceral adipose tissue independently contribute to cardiometabolic risk," they reported.

Dr. Gregg C. Fonarow, a professor of medicine at the University of California, Los Angeles, said the researchers had "done a really good job of looking past the conventional measurements of risk."
"This is another way by which clinicians can assess the degree of adiposity of patients as a measure of cardiovascular risk and make recommendations about reducing risk," he said.

But the basic message, Fonarow said, is that carrying too much fat is not good for the heart, no matter where in the body the fat happens to be.

"It is just another insight into how much adipose tissue there is," he said. "When you measure waist circumference, you look at visceral fat in the abdomen. Here you're looking at visceral fat in another area of the body."

"The study makes good sense to me," said Dr. Kirk Garratt, director of interventional cardiovascular research at Lenox Hill Hospital in New York City. "They are putting a quantifiable measurement on something we've known for some time -- that people with upper-body obesity are at heightened risk of cardiovascular disease."

The obese body comes in two forms, Garratt said: pear-shaped, with most of the excess weight around the hips; and apple-shaped, with most of the weight in the upper part of the body.
"People with most of the weight in the upper part of the body have more cardiovascular disease," Garratt said. "It appears to be that certain kinds of metabolic abnormalities contribute to the atherothrombotic risk."

But no matter where the excess fat is located, it's best to lose it, he said.

"Everybody who has a body-mass index over 25 increases the risk of coronary events, regardless of where they are carrying their weight," Garratt said.

Diabetes Care 2009;32:430-435.