Excess abdominal fat is a risk factor for diabetes, hypertension, and cardiovascular disease. There is data which indicates that stress increases the likelihood of adipose weight gain in the abdominal region,226 and that this type of weight gain is associated with an increased risk of hypertension, diabetes and CAD.932,939 The presence of abdominal fat (expressed as high waist-to-hip ratios) is predictive of elevated blood sugar and the subsequent development of diabetes.52,253 Several studies have suggested a link between alcohol consumption and increased abdominal obesity, however a study published in the American Journal of Epidemiology (November 15, 1995) by Carpenter et al reported that the type of alcohol, not alcohol itself was responsible for abdominal weight gain in adults. In this University of North Carolina study of 15,800 men and women, researchers found that drinking wine, although it contains calories and is fattening, resulted in thinner waistlines while sending the fat elsewhere. Consumption of beer was associated with a protruding abdomen, or "beer-belly".
Obesity is seen twice as often in black women as in white women,932,933,934,935 and the distribution of abdominal obesity is more prevalent among black women than in white women.937,938 In 1987, Gillum 936 found that abdominal adiposity appeared to increase the risk for Coronary Artery Disease (CAD) among both blacks and whites, but after adjusting for other risk factors, the increased risk fell short of full statistical significance. In 1993, research conducted by Bengtsson et al 943 of 1,462 women living in Gothenburg, Sweden who were followed for twenty years beginning in 1968, established the importance of abdominal fat as a significant predictor of heart disease in women. These authors found that a high waist-to-hip ratio among these female subjects, (indicative of excessive abdominal fat), was highly predictive (p=0.0002) of total mortality and death from AMI within the ensuing 20 years of follow up.
Subsequent research has demonstrated that abdominal fat is associated with coronary atherosclerosis, 946 CAD, 932 angiographically determined CAD, 932, 945 and risk of cardiovascular death in both men and women. 944, 945 Risk factors for CAD including elevated serum triglycerides, 943 high blood pressure, 932, 936, 938, 939 and adult-onset diabetes 52, 253, 932, 936, 939 have been associated with excessive abdominal fat in numerous studies and reviews. A recent study by Clark et al, 932 of 200 black women found that angiographically or electrocardiographically evident CAD was significantly more prevalent (p<0.001) among black women with the highest percentage of abdominal fat. These authors stated that "body fat distribution as measured by waist-to-hip circumference is an important risk factor for CAD that is easily determined." Subsequent researchers have postulated that this risk may be associated with the accumulation of abdominal fat around the internal organs which produces the larger waist-to-hip ratio more commonly seen in men, and this accumulation may be caused or accelerated by chronic stress. 226 Although this physiologic trait is more commonly associated with males, it is interesting to note that several studies of females who possess large waist-to-hip ratios indicative of abdominal fat storage, have suggested an increased risk of CAD, and this risk may be associated with, or secondary to chronic stress. For instance, the study conducted by Clark et al, 932 examined black women at an urban medical center in Brooklyn, New York who may have been under greater levels of stress than similar women in a suburban or rural setting.
Chronic stress, or the long-term endurance or vigilance response, results in the release of cortisol which stimulates and facilitates visceral fat storage. 492, 740 In addition to chronic stress, poor coping skills, inactivity, smoking, over-eating and excessive alcohol consumption, (all of which are more prevalent among the indigent), contribute to visceral obesity and increased CAD risk.10,52,740