Original Contributions Proposed Criteria for Metabolic Syndrome in Japanese Based on Prospective Evidence The Hisayama Study

Background and Purpose—The current criteria of metabolic syndrome (MetS) are not based on evidence derived from prospective studies on cardiovascular disease (CVD). Methods—In a 14-year follow-up study of 2452 community-dwelling Japanese individuals aged 40 years, we examined which of the MetS criteria are most predictive for the development of CVD. During the follow-up, 246 first-ever CVD events occurred. Results—An optimal cutoff point of waist circumference for predicting CVD was 90 cm in men (age-adjusted hazard ratio 1.81; 95% CI, 1.19 to 2.74; P 0.005) and 80 cm in women (age-adjusted hazard ratio 1.46; 95% CI, 0.99 to 2.16; P 0.05). A comparison of MetS criteria showed that the modified Japanese criteria using this cutoff point instead of the original definition were the strongest predictor of CVD events in both sexes (men: age-adjusted hazard ratio 2.58; 95% CI, 1.65 to 4.02; P 0.001; women: age-adjusted hazard ratio 2.39; 95% CI, 1.65 to 3.48; P 0.001). These observations remained robust even after adjustment for other confounding factors. According to this criteria set, only in the presence of central obesity, the hazard ratios for future CVD increased significantly as the number of MetS components increased, and a significant relationship was identified from 2 or more MetS components compared with individuals who had no MetS component. Conclusions—Our findings suggest that the optimal cutoff point of waist circumference is 90 cm in men and 80 cm in women and that the modified Japanese criteria of MetS with this cutoff point as an essential component better predict CVD in the general Japanese population. (Stroke. 2009;40:1187-1194.)