Background: It is controversial whether metabolic syndrome (MS) predicts subclinical atherosclerosis independent of conventional risk factors in non-diabetic subjects. Subjects & Methods: A total of 1293 adults underwent carotid ultrasound examinations, brachial-ankle pulse wave velocity (baPWV) measurements, and ankle-brachial pressure index (ABI) determinations during health check-up. None had manifest cardiovascular disease (CVD), diabetes, and current medication for hypertension or dyslipidemia. Subclinical atherosclerosis was defined as follows: carotid atherosclerosis (CA) as a carotid plaque or carotid intima-media thickness >75th percentile; high baPWV as >1450 cm/s; low ABI as < 1.00. Results: In univariate analysis, MS was associated with increased prevalences of CA (46.6 vs 33.9%, p<0.001) and high baPWV (52.6 vs 33.1%, p<0.001), but not with low ABI (7.0 vs 8.5%, p=NS). Subjects with MS had higher Framingham 10-year CHD risk (F) (7.3짹6.3 vs 5.3짹5.1%, p<0.001) and 10-year general CVD risk (G) (12.5짹7.2 vs 8.5짹6.2%, p<0.001) than those without MS. The ROC statistic by MS, F, and G was 0.56, 0.66, and 0.73, respectively, for the prediction of CA; 0.59, 0.61, and 0.73, respectively, for the prediction of high baPWV. After controlling for age, sex, current smoking, BP, total cholesterol, and HDL-cholesterol, MS was not associated with CA or high baPWV (OR of CA 0.99, 95% CI 0.73-1.35; OR of high baPWV 1.01, 95% CI 0.72-1.41; both p=NS). . Conclusion: This suggests that MS is not an independent predictor of subclinical atherosclerosis. Conventional risk factors might be more important than MS in addressing subclinical atherosclerosis in non-diabetic subjects.