objective The cardiovascular risk factors which comprise the metabolic syndrome are associated with increased hypothalamic–pituitary–adrenal axis (HPAA) activity in some Caucasian populations. South Asians have high rates of cardiovascular disease and its risk factors. We have investigated the relationships between HPAA activity, adiposity and the metabolic syndrome in a South Asian population.

design Cross‐sectional cohort study.

participants A total of 509 men and women born at the Holdsworth Memorial Hospital, Mysore, South India between 1934 and 1954 and still living in the area.

measurements Fasting 09·00 h cortisol and corticosteroid‐binding globulin. The cohort had previously been investigated for features of the metabolic syndrome.

results At 09·00 h, cortisol concentration was strongly associated with systolic and diastolic blood pressure (r = 0·25 and r = 0·24, respectively; P < 0·001), fasting glucose concentration (r = 0·26; P < 0·001), insulin resistance (r = 0·20; P < 0·001) and fasting triglyceride concentration (r = 0·17; P < 0·001). In general, higher cortisol concentrations added to the effect of adiposity in increasing cardiovascular risk factors, but there was evidence of an interaction between cortisol and adiposity in determining fasting glucose concentration (P = 0·045) and insulin resistance (P = 0·006).

conclusions Associations between 09·00 h cortisol concentration and cardiovascular risk factors in this South Asian cohort were stronger than those previously shown in Caucasian populations, despite similar mean cortisol concentrations, and were amplified by adiposity. This suggests that increased glucocorticoid action may contribute to ethnic differences in the prevalence of the metabolic syndrome, particularly among men and women with a higher body mass index.