People with coronary artery disease are at greater risk of dying if they have fat around the waist, a study has found.

Researchers said sufferers with even a “modest” beer belly or muffin top have up to twice the risk of dying compared to those whose fat collects elsewhere. The effect was even observed in patients with a normal Body Mass Index who had just a thin layer of flab around their midriff.

The waist circumference and waist-to-hip ratio of nearly 16,000 people were analysed by re-searchers from the Mayo Clinic in the US as part of the study. They found that carrying fat around the belly was potentially as dangerous as smoking a pack of cigarettes per day or having very high cholesterol.

Previous studies have shown that patients with a higher BMI and chronic diseases such as coronary artery disease have better survival odds than normal-weight individuals. However, the latest findings go against this “obesity paradox”, researchers said.