The way to a person’s heart may be through his or her stomach in more ways than one. Doctors have tied heart health to the abdomen, and having extra pounds around one’s middle can be detrimental to cardiovascular well-being.

Excess visceral fat in the belly, something doctors refer to as “central adiposity,” may have potentially dangerous consequences. While the link between belly fat and heart health has long been associated with men, women may be even more vulnerable to the adverse health effects of belly fat. A study published in March 2018 in the Journal of the American Heart Association examined 500,000 people between the ages of 40 and 69. Participants had their body measurements taken, and then were kept track of for heart attack occurrence over the next seven years. During that period, the women who carried more weight around their middles (measured by waist circumference, waist-to-hip ratio or waist-to-height ratio) had a 10 to 20 percent greater risk of heart attack than women who were just heavier over all.

Belly fat is particularly dangerous because it doesn’t just include the insulating, or subcutaneous, fat under the skin. It is largely visceral fat that also surrounds the organs in the abdomen. Harvard Medical School reports that visceral fat is metabolically active and has been strongly linked to a host of serious diseases, including heart disease, diabetes, cancer, and dementia. Visceral fat is like an endocrine organ that secretes hormones and a host of other chemicals linked to diseases that can affect adults. One substance is called retinol-binding protein 4 (RBP4), which has been tied to an increased risk of coronary heart disease. In 2015, a study published in the Annals of Internal Medicine found that normal-weight people with excessive belly fat had a higher risk of dying of heart disease or any other cause compared with people without central obesity.

The online health and wellness resource Medical News Today says doctors determine belly fat to be a problem when a woman’s waist measures 35 inches or more and a man’s 40 inches or more. MRIs also can be used as a fat analyzer and will be judged on a scale of 1 to 59. A measurement of 13 and under is desirable.

The Mayo Clinic advises that poor diet and fitness habits can contribute to belly fat. As people age, they may have to make more drastic changes to their diets and exercise regimens to counteract changes in their metabolisms. Eliminating sugary beverages, watching portion sizes, counting calories, doing moderate aerobic activity daily, and choosing healthier foods can help tame visceral fat. Also, doctors may recommend those who are stressed to try stress-busting techniques, as stress also may be tied to excessive belly fat.

Belly fat should not be overlooked, as its presence can greatly increase a person’s risk for various diseases.