Background:The clinical significance of metabolic syndrome (MS) score,MS,and its individual components with respect to risk prediction of coronary artery disease (CAD) remains unclear.The objective of this study was to investigate whether and to what extent MS score,MS,and its individual components were related to the risk of CAD.Methods:Among 1191 participants who underwent coronary angiography for the confirmation of suspected myocardial ischemia,858 were included in this study according to the inclusion criteria from September 2010 to June 2013.MS was diagnosed with the 2005 National Cholesterol Education Program Adult Treatment Panel III criteria.The severity of coronary atherosclerosis was assessed by Gensini score.Results:The results showed that the age-and sex-adjusted odds ratios (ORs) for CAD were as follows:MS score,1.327;MS,2.013;elevated waist circumference,1.447;reduced high-density lipoprotein cholesterol,1.654;and elevated fasting glucose,1.782;all P ＜ 0.05;whereas for elevated triglycerides,1.324,and elevated blood pressure,1.342,both P ＞ 0.05.After multivariate adjustment,results showed that only MS and elevated fasting glucose were significantly associated with CAD (OR,1.628,95％ confidence interval [CI],1.151-2.305,P =0.006 for elevated fasting glucose,and OR,1.631,95％ CI,1.208-2.203,P =0.001 for MS).The study showed that only MS score and elevated fasting glucose were significantly associated with Gensini score (standardized coefficient,0.101,P =0.031 for elevated fasting glucose and standardized coefficient,0.103,P =0.009 for MS score).Conclusions:The present study demonstrated that MS score,MS,and its individual components might have different contributions to CAD prevalence and severity.MS and elevated fasting glucose were independent risk factors for the prevalence of angiographic CAD whereas MS score and elevated fasting glucose were significantly associated with the severity of CAD.