Abstract: Objective To analyze the association between metabolic syndrome(MS)and cardio-cerebrovascular disease and total mortality.Methods A 8-year follow-up study was conducted among 2 589 Mongolian people aged 20-84 years.The observed outcomes were cardio-cerebrovascular disease(stroke and coronary heart disease)and total mortality.Multivariate proportional hazards model was adopted to analyse the hazard ratios(HR)and their 95% confidence intervals(95%CI)of MS and other risk factors for multilple outcomes.Results Among all participants,the lost to follow-up rate was 0.23% and the total follow-up person-years were 18 543.There were 261 incidences of cardiovascular and cerebrovascular diseases observed.During the follow-up,the incidence density of stroke and coronary heart disease were 533.9/100 000 and 253.5/100 000 person-years,respectively,and the mortality density was 620.2/100 000 person-years.After djusting for age,gender,and the history of hypertension,multi-factor proportional hazards model analyses showed that MS was associated with the outcome,with the HR(95% CI)of 1.33(1.02-1.74)(P=0.034).ConclusionMS may increase the risk of cardiovascular disease and total mortality by 33% in Mongolian population,suggesting MS could predict the incidence of cardiovascular disease and death.