OBJECTIVES: The purpose of this study is to analyze the underlying associations between coronary risk factors and the metabolic syndrome on a previously studied cohort of 284 middle-aged Caucasian males from Sweden. These associations were then placed in context of current Adult Treatment Panel III guidelines for diagnosing metabolic syndrome and American College of Endocrinology guidelines for diagnosing insulin resistance syndrome. METHODS: A confirmatory factor analysis was performed using EQS Multivariate Software Version 5.7b with maximum likelihood estimation. Hypertension, obesity, insulin resistance, cholesterol, and hyperlipidemia were the latent factors studied. RESULTS: Cholesterol was not significantly associated (p <0.05) with either obesity (r=0.015) or insulin resistance (r=-0.042), giving further support to the possibility of multiple risk factors for predicting coronary heart disease in addition to elevated LDL cholesterol. Significant correlations (p <0.05) were noted between obesity and hyperlipidemia (r=0.583), obesity and insulin resistance (r=0.899), and insulin resistance and hyperlipidemia (r=0.928). CONCLUSION: These associations are discussed in the context that the average patient did not meet Adult Treatment Panel III defined criteria for metabolic syndrome. We suggest that more stringent guidelines such as those suggested by the American College of Endocrinology may be necessary to identify and diagnose the pathophysiologic risk factors involved in the metabolic syndrome. One suggestion may be to include an oral glucose tolerance test to help in evaluation of insulin resistance. More stringent cut-offs for abnormal values of triglycerides and HDL cholesterol may also be required. We also suggest that research of the metabolic syndrome may be better accomplished by focusing on individual physiologic components rather than focusing on one single etiology to quantify, which is an approach that has been taken in previous research.