A recent Euro-pean study examined the contribution of the metabolic syndrome to the risk of developing venous throm-boembolism (VTE). This case?control study was designed to investigate the presence of the metabolic syndrome, defined according to guidelines of the National Cholesterol Education Program, in high-risk patients with objectively confirmed recurrent VTE who had had at least 1 unprovoked event of deep vein thrombosis or pulmonary embolism. A total of 116 VTE patients and 129 controls were enrolled. The prevalence of the metabolic syndrome was statistically significantly higher in VTE patients (40/116; 35%) than in controls (26/129; 20%; P = .012). The adjusted odds ratio of the metabolic syndrome for VTE was 2.2 after adjustment for established thrombosis risk factors, sex, and age. Individuals with the metabolic syndrome (n = 66) had significantly higher levels of high-sensitivity C-reactive protein, fibrinogen, and factor VIII activity, compared with patients without metabolic syndrome.