December 2014, 22:18

19 December 2014

Original Article

Original Article

Elevated cardiovascular risk factors in a young, asymptomatic and physically active population within a normal body mass index

Lee GK, Sim HW, Tan Y, Ma T, Liew KH, Tan EC, Lee LC, Sum CF, Ong HY

ASEAN Heart Journal

First online: 

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Obesity is associated with significant morbidity and mortality. The body mass index (BMI) is a simple and inexpensive technique to quantify obesity. In a low-risk population, we aim to determine the association of BMI with cardiovascular risk factors (CVRFs) including undiagnosed diabetes.


We studied 3026 subjects referred for routine health screening. Patients with pre-existing diabetes mellitus and/or vascular disease were excluded. Each subject had anthropometric measurements and CVRF parameters (blood pressure, fasting lipids and fasting glucose) taken.


The mean age was 38.9 ± 5.4 years, 89.9% male. Chinese persons comprised 58.6% of our cohort, Malays 34.0% and Indians 7.4%. The majority (84.5%) of subjects were low-risk (10-year risk <10%) for cardiac events using the FRS algorithm. The mean BMI was 25.2kg/m2. A positive correlation was seen between BMI and prevalence of CVRFs (p<0.001 for all). Serum lipid levels worsen significantly beyond a BMI of 20.0kg/m2, while blood pressure worsens significantly beyond a BMI of 22.0kg/m2. A positive relationship between BMI and the prevalence of impaired fasting glucose and frank diabetes was noted for BMIs ≥20.0kg/m2 (p<0.001); no subject below 20.0kg/m2 had frank diabetes.


A significant proportion of our subjects with a normal (Asian) BMI of <23.0kg/m2 had elevated CVRFs on routine screening. The step-wise rise and additive nature of these CVRFs and her consistent correlation with a rising BMI of >20.0kg/ m2 suggest that traditional cardiovascular risk factors can be reduced to very low levels by weight reduction alone.


body mass index - Asian - diabetes mellitus - hypertension - hyperlipidemia





Running title: Increase in cardiovascular risk factors.

Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Department of Medicine (Drs. Lee GK, Sim HW, Tan Y) National University Health System, Singapore;

Health for Life Program (Drs. Ma T, Liew KH, Tan EC) Khoo Teck Puat Hospital, Singapore;

Gleneagles Hospital Penang, (Dr. Lee LC), Penang, Malaysia;

Departments of Medicine (Dr. Sum CF) and Cardiology (Dr. Ong HY), Khoo Teck Puat Hospital, Singapore.

Reprints: Dr. Ong HY, Department of Cardiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, (65) 66023971 Email:


Tel No: +603-7931 7900
Fax No: +603-7932 1400



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