African-American women can be at risk of heart disease even if they don't have metabolic syndrome, a study finds.

That's a problem, because the current thinking is that metabolic syndrome — defined as high triglycerides, bad cholesterol, abdominal fat, high blood pressure and impaired glucose metabolism — is the big risk factor for heart attacks and strokes.

The picture with women appears to be a lot more complicated, especially when you compare women in different racial or ethnic groups.

This study, published Wednesday in the Journal of the American Heart Association, found that having just having two metabolic abnormalities raised heart disease risk in African-American women. Being overweight or obese with two or three metabolic factors almost doubled their heart disease risk.

That wasn't true for white women. For them, being overweight or obese didn't boost their risk unless they had full-on metabolic syndrome, too.

"The metabolic health concept has has only been investigated in the white population," says Dr. Michelle Schmiegelow of Copenhagen University Hospital Gentofte in Denmark. She led the research while at Stanford University. "We found that it cannot be directly applied to black individuals."

Looking just at metabolic syndrome will underestimate risk in African-American women and overestimate it in white women, Schmiegelow says.

This study looked at data from 14,364 postmenopausal women who participated in the Women's Health Initiative, tracking their health for 13 years. Hispanic women were included, but there weren't enough of them to come to any firm conclusions.

"There's a lot we don't know," says Dr. Robert Eckel, a professor at the University of Colorado's Anschutz School of Medicine who was not involved in the study. "Does culture or race, environmentally or genetically, have impacts that we can't quite assess accurately?"

It also raises the question of how the health effects of race and culture vary around the globe, Eckel says.

And it shows that a one-size-fits-all approach to health risks doesn't cut it.

"You have to make an individual risk assessment," Schmiegelow told Shots. "I'm really hoping this study will motivate other groups to see if they can replicate our finding in men or in other races and ethnicities."

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