title: Should central obesity be an optional or essential component of the metabolic syndrome? Ischemic heart disease risk in the Singapore Cardiovascular Cohort Study.
abstract: 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).
  
  
  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.
authors.affiliation: Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, MD3, National University of Singapore, 16 Medical Drive, Singapore 117597. cofleejm@nus.edu.sg
authors.forename: Jeannette
authors.initials: J
authors.lastname: Lee
authors.forename: Stefan
authors.initials: S
authors.lastname: Ma
authors.forename: Derrick
authors.initials: D
authors.lastname: Heng
authors.forename: Chee-Eng
authors.initials: CE
authors.lastname: Tan
authors.forename: Suok-Kai
authors.initials: SK
authors.lastname: Chew
authors.forename: Kenneth
authors.initials: K
authors.lastname: Hughes
authors.forename: E-Shyong
authors.initials: ES
authors.lastname: Tai
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology*; D000328:Adult; D015992:Body Mass Index; D049628:Body Size; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006306:Health Surveys; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology*; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology*; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore / Q000453:epidemiology
chemical_list: D008055:Lipids