The authors investigated the associations between target organ damage and individual components of the metabolic syndrome (MS) compared with the MS itself. Carotid intima-media thickness (IMT), carotid plaque, and left ventricular mass index (LVMI) were assessed by ultrasonography in 356 participants who were free of overt cardiovascular disease. Participants with the MS (n=33) had higher LVMI and carotid IMT than those without the MS (n=323), but the percentage of patients who had carotid plaque was similar. Individually, each component of the MS was significantly associated with the 3 measures of target organ damage. In bivariate and multivariate analyses, the association of clinic systolic blood pressure to both LVMI and carotid IMT and the negative association of high-density lipoprotein cholesterol with carotid plaque were stronger than and independent of the MS. The data suggest that physicians should evaluate blood pressure and high-density lipoprotein cholesterol as well as other cardiovascular risk factors without regard to whether a patient meets the criteria for the MS.