Factors associated with an increased risk of developing coronary heart disease (CHD) tend to cluster in individuals and are referred to as the metabolic syndrome. To evaluate the prevalence and demographic lifestyle factors associated with the metabolic syndrome in a representative sample of US adults, data were evaluated from adults participating in the NHANES III conducted between 1988 and 1994. The metabolic syndrome was present in 22.8% and 22.6% of US men and women, respectively. The age-specific prevalence was highest in Mexican Americans and lowest in black Americans of both sexes. The metabolic syndrome prevalence increased with body mass index (Figure). Older age, postmenopausal status, Mexican American ethnicity, higher body mass index, current smoking, low household income, high carbohydrate intake, no alcohol consumption, and physical inactivity were associated with increased odds of the metabolic syndrome. The metabolic syndrome is present in over 20% of the adult US population; varies substantially by ethnicity even after adjusting for body mass index, age, socioeconomic status, and other predictor variable, and other predictor variables; and is associated with several potentially modifiable lifestyle factors. Identification and clinical management of this high-risk group is an important aspect of CHD prevention.