Given that the clinical identification of the metabolic syndrome varies according to ethnicity, the association between the metabolic syndrome and coronary artery disease (CAD) was examined in a sample of African Americans (n=224) and European Americans (n=304). The prevalence of CAD was greater in patients with the metabolic syndrome, regardless of ethnicity (71.1% (p=0.017) and 56.6% (p=0.046) for European Americans and African Americans, respectively). The two lipid variables (triglycerides and HDL cholesterol) for clinical identification of the metabolic syndrome were less frequent in African American than in European American patients. Although the influence of ethnicity must be taken into account in order to understand how metabolic syndrome variables are related to cardiovascular risk, these results suggest that the metabolic syndrome is a high-risk cardiovascular condition independent of ethnicity.