You may look healthy as hidden fat silently damages your heart

By Sola Ogundipe

Although you may appear to be in excellent condition and your Body Max Index (BMI) shows you’re in the clear, deadly fat accumulated deep inside your abdomen and liver can be secretly damaging your arteries.

This is the staggering finding of a large new study by McMaster University researchers, who are warning that “hidden fat” can be far more damaging to the heart than ever before imagined.

The research, published in Communications Medicine, used MRI scans to study more than 33,000 adults in the United Kingdom and Canada. The results show deep fat surrounding internal organs (visceral fat) and fat in the liver (hepatic fat) are closely linked with thickening of the carotid arteries – the large arteries that bring the brain oxygen. When the arteries become narrowed, heart attack and stroke risk skyrockets.

This study shows that even after controlling for cholesterol, blood pressure, and other known risk factors, visceral fat and liver fat both play a role in injuring arteries,” said Dr. Russell de Souza, lead co-author and associate professor at McMaster’s Department of Health Research Methods, Evidence, and Impact.

The results overturn one of the oldest medical assumptions: that body mass index (BMI) is a good gauge of health. The scientists discovered that numerous individuals with “normal” BMI levels still had lethal internal fat lurking beneath their surfaces that was capable of damaging their arteries—disproving the slogan “looks are deceiving.”

Dr. de Souza and co-author Dr. Marie Pigeyre of McMaster’s Department of Medicine analyzed detailed MRI data from two large population studies, the Canadian Alliance for Healthy Hearts and Minds (CAHHM) and the UK Biobank.

Visceral fat was significantly associated with plaque and artery wall thickening, while liver fat had a lesser but nonetheless significant effect. These risks remained even when lifestyle variables such as diet, exercise, and cholesterol were controlled for.

“The findings are an eye-opener for physicians and the public. Doctors and patients need to be aware of fat that cannot be seen beyond what you can see on the outside,” said de Souza, who is also a member of McMaster’s Centre for Metabolism, Obesity and Diabetes Research

For decades, BMI and waist measurement have been the standard for measuring obesity and heart disease risk. But according to Dr. Sonia Anand, lead author of the study and a vascular medicine specialist with Hamilton Health Sciences, that approach misses the silent danger.

You can’t just glance at someone and know if they have visceral or liver fat,” Anand said. “This type of fat is active metabolically and harmful—it spurs inflammation and artery disease even in individuals who are not outwardly overweight. If we’re going to prevent heart attack and stroke better, we need to recast how we define and measure obesity.”

The researchers describe imaging tests that reveal fat that envelops inner organs might provide a much more accurate measure of cardiovascular health than BMI alone. As MRI technology becomes more widespread, clinicians may soon have better tools for detecting these hidden risks early.

For those in middle age—especially those who believe that weight keeps them safe—the findings are ominous: healthy BMI does not necessarily translate to a healthy heart.

The study was supported by Canadian Partnership Against Cancer, Heart and Stroke Foundation of Canada, and Canadian Institutes of Health Research, with further support from the Population Health Research Institute, Montreal Heart Institute, and Sunnybrook Health Sciences Centre. The MRI reading charges were supported by Sunnybrook Hospital, and contrast for imaging was supplied by Bayer AG.

As Anand has put it, “Prevention of heart disease must go below the surface—literally. The invisible fat can be the most lethal of all.

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