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Should Central Obesity Be an Optional or Essential Component of the Metabolic Syndrome?

Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study

¹ Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
² Ministry of Health, Singapore
³ Center for Molecular Epidemiology, Faculty of Medicine, National University of Singapore, Singapore
⁴ Department of Endocrinology, Singapore General Hospital, Singapore

Address correspondence and reprint requests to Jeannette Lee, Community, OccupationalFamily Medicine, Yong Loo Lin School of Medicine, MD3, National University of Singapore, 16 Medical Dr., Singapore, 117597. E-mail: cofleejm{at}nus.edu.sg

OBJECTIVE—The International Diabetes Federation (IDF) proposes that central obesity is an "essential" component of the metabolic syndrome, while the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) proposes that central obesity is an "optional" component. This study examines the effect of the metabolic syndrome with and without central obesity in an Asian population with ischemic heart disease (IHD).

RESEARCH DESIGN AND METHODS—From the population-based cohort study (baseline 1992–1995), 4,334 healthy individuals were grouped by the presence or absence of the metabolic syndrome and central obesity and followed up for an average of 9.6 years by linkage with three national registries. Cox’s proportional hazards model was used to obtain adjusted hazard ratios (HRs) for risk of a first IHD event.

RESULTS—The prevalence of metabolic syndrome was 17.7% by IDF criteria and 26.2% by AHA/NHLBI criteria using Asian waist circumference cutoff points for central obesity. Asian Indians had higher rates than Chinese and Malays. There were 135 first IHD events. Compared with individuals without metabolic syndrome, those with central obesity/metabolic syndrome and no central obesity/metabolic syndrome were at significantly increased risk of IHD, with adjusted HRs of 2.8 (95% CI 1.8–4.2) and 2.5 (1.5–4.0), respectively.

CONCLUSIONS—Having metabolic syndrome either with or without central obesity confers IHD risk. However, having central obesity as an "optional" rather than "essential" criterion identifies more individuals at risk of IHD in this Asian cohort.

Abbreviations: AHA/NHLBI, American Heart Association/National Heart, Lung, and Blood Institute • AP_E, attributable percent among those with metabolic syndrome • AP_T, attributable percent among the total population • CVD, cardiovascular disease • IDF, International Diabetes Federation • IHD, ischemic heart disease

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