The study, published on January 22, 2025, reveals that individuals with greater amounts of fat embedded in their muscles are more likely to experience coronary microvascular dysfunction (CMD)—a condition where the tiny blood vessels in the heart become damaged. This dysfunction is closely linked to a higher risk of hospitalization or death due to heart attacks or heart failure.

While obesity is widely recognized as a major global health threat, the current reliance on BMI to assess cardiovascular risk may not be sufficient for all individuals, especially women. BMI has been shown to fail in accurately assessing the heart disease risks for those with higher muscle fat. In fact, for some people, particularly women, high BMI can reflect “benign” fat types that do not contribute to cardiovascular problems, Taqueti explained.

The research analyzed the muscle fat of 669 individuals, all of whom were undergoing evaluation for chest pain or shortness of breath at Brigham and Women’s Hospital. None of the participants had obstructive coronary artery disease. The study followed these patients for about six years, monitoring their heart health and hospitalizations for heart failure or heart attack. Those with higher amounts of intermuscular fat were more likely to develop CMD and subsequently experience severe heart-related events.

This groundbreaking study highlights the need for more precise measures of heart disease risk that go beyond traditional markers like BMI and waist circumference. It suggests that body composition, particularly fat within the muscles, plays a critical role in cardiovascular health, potentially offering new avenues for early detection and intervention.

Professor Taqueti’s team hopes these findings will lead to more personalized strategies for assessing and treating cardiovascular risks, especially for those whose BMI may not fully capture the dangers lurking beneath the surface.

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