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The association between abdominal obesity and an increased risk of cardiovascular disease (CVD) is now well recognized. Both problems are becoming more prevalent within the Asia-Pacific region, but there are substantial differences within and between countries. The strength of the temporal relationship between obesity and CVD in the region has led to the suggestion that obesity is the driving force behind the continuing epidemic of CVD. This raises the question as to whether there are any special aspects to the Asia-Pacific epidemic of obesity and resultant problems as a result of genetic or developmental factors. It is clear that the experience of central obesity and its cardiovascular consequences in western society cannot be directly transposed to all countries in the region. Issues such as smoking, alcohol use and inactivity may carry different implications. The Asia-Pacific region has started from low baseline prevalence of both obesity and CVD. but this implies that the potential for major problems in the future is particularly severe.