The metabolic syndrome is a constellation of cardiovascular disease risk factors, and it is associated with the presence of advanced subclinical coronary atherosclerosis. The presence of the metabolic syndrome appears to provide incremental predictive value on top of the Framingham risk score in predicting future cardiovascular events. Traditional risk-prediction formulas fail to account for a significant portion of coronary heart disease morbidity and mortality. The metabolic syndrome may be particularly useful in predicting risk among individuals classified as low or intermediate risk by Framingham risk score.