ObjectiveThe aim of the study was to investigate the prevalence of metabolic syndrome (MetSyn), associated factors, and optimal waist circumference (WC) cut points in a subset of the elderly population in Asmara, Eritrea.DesignA community-based cross-sectional study conducted between January and June 2018.SettingAsmara, Eritrea.ParticipantsDemographic, clinical biochemistry and anthropometric information were collected from a total of 319 elderly participants of African lineage (54.5% men vs 45.5% women).Main outcome measuresLipid profiles, fasting plasma glucose (FPG), anthropometric data, clinical profiles and demographic characteristic of patients were described. MetSyn was defined according to the International Diabetes Federation harmonised criteria.ResultsThe median age (IQR) of study participants was 67 (IQR: 63–72 years)—men 68 (IQR: 64–74) years versus women 65 (IQR: 62–70) years, p=0.002. The prevalence of MetSyn was 90 (28.4%). Abnormal values in MetSyn components were as follows: systolic blood pressure/diastolic blood pressure ≥130/85 mm Hg or use of hypertension medication 133 (41.7%); overweight/obesity, 55 (25.1%); abdominal obesity 129 (40.4); low-density lipoproptein cholesterol (LDL-C) >130 mg/dL, 139 (43.6%); total cholesterol >200 mg/dL, 152 (47.6%); non-high-density lipoproptein cholesterol (HDL-C)>130 mg/dL, 220 (69.0%) and FPG (≥100–125 mg/dL), 35 (12.7%) and FPG>125.17 (6.2%). Multivariate logistic regression analysis indicated that sex (females) (adjusted OR (aOR) 4.69, 95% CI 2.47 to 8.92); non-HDL-C (aOR 1.09, 95% CI 1.05 to 1.14); LDL-C >130 mg/dL (aOR 2.63, 95% CI 1.09 to 6.37) and body mass index (aOR 1.20, 95% CI 1.10 to 1.32) were independently associated with the presence of MetSyn. Optimal cut points for WC in men yielded a value of 85.50 cm, a sensitivity of 76.0%, a specificity of 61.0% and an area under receiver operating characteristics curve (AUROC) value of 74.0, 95% CI (65.7 to 82.4). For women, the WC at a cut point value of 80.50 cm yielded the highest Youden index (0.41) with a sensitivity of 80%, a specificity of 39%, and an AUROC of 73.4, 95% CI (64.8 to 82.5).ConclusionsThe MetSyn is highly prevalent in a subset of apparently healthy elderly population in Asmara, Eritrea. The findings support opportunistic and/or programmatic screening for CVD risk in the elderly during outpatient visits.