Metabolic syndrome (MS) is defined as a cluster of the most dangerous heart attack risk factors: diabetes and prediabetes, abdominal obesity, high cholesterol and high blood pressure [1]. M. Thiruvagounder et al. (2010) [2] reported that people with MS are about twice as likely to develop cardiovascular disease (CVD) and over four times as likely to develop Type 2 diabetes compared to subjects without metabolic syndrome. Asian Indians have strong predisposition to MS and CVD [3], which has been shown through several studies on Indians living in India [4,5] and abroad [6,7].

Traditional CVD risk factors account for only around 50% of cardiovascular morbidity and mortality [8]. Thus, the importance and utility of newer predictors have been emphasized as an additional means of early detection of CVD risk [9]. These novel markers may be useful in predicting risk in addition to the conventional risk factors [10].

The 20^th century has seen the emergence of substantial evidence to prove homocysteine (primarily atherogenic marker), C-reactive protein and fibrinogen (primarily thrombosis marker) [1,11] as the newer risk factors for CVD amongst Asian Indians.

Homocysteine (Hcy), a homologue of the naturally occurring amino acid cysteine, has been touted as one of the new-age inflammatory markers of CVD risk. In 1969, autopsy of children with homocystinuria revealed presence of severe atherosclerosis demonstrating pathogenic role of homocysteine [12]. Thereafter, the second phase of NHANES III (1991-1994) included study of homocysteine understanding its significance as more than just a marker of vitamin deficiency. A study by R. Carmel et al. (2002) [13] found that Asian Indian population residing in US have significantly higher Hcy levels compared to men from 4 other ethnic groups with 25.6% being hyperhomocysteinemic. They concluded that hyperhomocysteinemia is common among apparently healthy Asian Indian men accompanied by subclinical cobalamin deficiency.

Similarly, P.E. Szmitko et al. (2003) [14] reported that CRP may play a direct active role in the pathogenesis of atherosclerosis through its inflammatory action in blood vessels. C-reactive protein (CRP) is an acute phase reactant that increases in response to systemic inflammation such as infection or tissue injury [15]. Inflammation causes release of cytokines, especially Interlukin-6, which is largely responsible for triggering the production of CRP from the liver. Studies have shown that high sensitivity CRP consistently predicts new coronary events in patients with unstable angina and acute myocardial infarction [16,17].

The normal levels for the Homocysteine and CRP have been calculated for the Western population. The present study has assessed the Homocysteine and CRP level among Asian Indians with metabolic syndrome at risk for CVD and compared the value with the normal data.

Subjects with metabolic syndrome were identified based on the guideline provided by modified National Cholesterol Education Program—Adult Treatment Panel III [18] for Asians. These include presence of higher abdominal waist circumference, high blood pressure, hypertriglyceridemia, low HDL cholesterol and. high blood glucose. Individuals exhibiting at least three or more of these parameters simultaneously were selected.

It has been noted that coronary artery disease occurs 10 years earlier among South Asian Indians compared to other populations across the world and develop metabolic abnormalities at a lower body mass index and waist circumference thereby leading to 25% to 50% underestimation of MS prevalence [43].

Table 1 shows the basic demographic profile of the subjects enrolled from the cosmopolitan city Mumbai, India. The average age of the women subjects was 50 years with majority being in obese category as indicated by a higher average BMI. BMI cut-offs for defining “overweight” and obesity in Asian Indians are 23 kg/m² and 25 kg/m² respectively [5].