title: An evaluation of metabolic risks for coronary death in the Asia Pacific region.
abstract: OBJECTIVE
  To investigate the generalizability of current definitions of the metabolic syndrome in Asia-Pacific populations, and whether information on metabolic risk factors could be better used to discriminate fatal coronary heart disease (CHD) risk.
  
  
  RESULTS
  Analyses were performed on individual participant data from 26 cohorts involving 329, 166 participants from the Asia Pacific region. Sensitivity and specificity estimates for CHD death associated with cut-points as defined by the U.S. National Cholesterol Education Panel (NCEP) were determined for component risk factors of a modified NCEP-defined metabolic syndrome. Five cohorts (6437 subjects, 53 CHD deaths) measuring all five risk factors at baseline were used to evaluate the association between the metabolic syndrome and CHD, and to compare risk discrimination using a definition including each risk factor as a continuous variable. Sensitivity and specificity estimates for risk factor cut-points varied considerably by region (Asia versus Australia/New Zealand) and moderately by sex. The adjusted hazard ratio for CHD death associated with the modified NCEP-defined metabolic syndrome was 2.05 (95%CI, 1.13-3.72). On receiver operator characteristic analysis, the area-under-the-curve for CHD death was 0.586 (95%CI: 0.439-0.732) for the modified NCEP-defined metabolic syndrome, and 0.733, 95%CI: 0.664-0.802) for a definition including each of the metabolic risk factors in their continuous form.
  
  
  CONCLUSIONS
  Specific cut-points for metabolic risk factors are not generalizable between populations. This finding is not restricted to measures of central obesity. A multivariable definition of the metabolic syndrome including all risk factors as continuous variables improves CHD risk discrimination substantially.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: F
authors.initials: F
authors.lastname: Barzi
authors.forename: M
authors.initials: M
authors.lastname: Woodard
authors.forename: C
authors.initials: C
authors.lastname: Ni Mhurchu
authors.forename: T
authors.initials: T
authors.lastname: Ohkubo
authors.forename: T H
authors.initials: TH
authors.lastname: Lam
authors.forename: T
authors.initials: T
authors.lastname: Welborn
mesh_terms: D000328:Adult; D000368:Aged; D001208:Asia / Q000453:epidemiology; D044466:Asian People; D003327:Coronary Disease / Q000209:etiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications*; D008875:Middle Aged; D010139:Pacific Islands / Q000453:epidemiology; D012307:Risk Factors; D012680:Sensitivity and Specificity