Background: Metabolic syndrome is a well known cardio-cerebro-vascular risk factor. The aim of the present study was to investigate the differences of the impact of metabolic syndrome in the survivors of ischemic stroke according to the age groups. Methods: A total of 584 patients with ischemic stroke were divided into 2 groups; the younger group (age<65 years, n=270, 159males) versus the elderly group (age���65 years, n=314, 177males). Metabolic syndrome was defined according to the guidelines established by the National Cholesterol Education Program and American Association of Clinical Endocrinologists Criteria. Results: The incidence of metabolic syndrome was 25.4% in the younger group and 29% in the elderly group, which incidence was not significantly different between the groups. Metabolic syndrome was not associated with carotid intima-media thickness (IMT) or the presence of carotid plaques in the elderly group. Metabolic syndrome was also no significant predictor for recurrence or other vascular event in older group. However, metabolic syndrome was strongly correlated with carotid IMT (Rt CCA IMT; r=0.215, p<0.001, Lt CCA IMT; r=0.265 p<0.001) in young group. Carotid plaque (32% vs. 18.5%, p=0.002) and recurrent vascular events including death, recurrent stroke or other vascular complications (45.7% vs. 32.5%, p=0.034) combined with metabolic syndrome were significant frequent in young group. In regression analysis, metabolic syndrome was not independent risk factor in both age groups, but the increased carotid IMT (HR=1.717, CI=1.020-2.891, p=0.042) and the presence of carotid plaque (HR=2.081, CI=1.158-3.739, p=0.014) were independent predictors for recurrent vascular event in the younger group (HR 1.717, CI 1.020-2.891, p=0.042). Conclusions: Metabolic syndrome was related with carotid atherosclerosis and vascular prognosis in the younger patients, but not in the elderly patients with ischemic stroke. Metabolic syndrome was not a predictor of recurrent vascular events in the elderly patients with ischemic stroke.