ERSONS WITH THE METABOLIC syndrome are at increased risk of developing type 2 diabetes and coronary heart disease (CHD) as well as increased mortality from CHD and other causes. 1,2 Findings from the Third National Health and Nutrition Examination Survey showed that prevalence of metabolic syndrome increased with age from 6.7% among participants aged 20 to 29 years, to 43.5% for participants aged 60 to 69 years, and 42.0% for those aged 70 years or older. 3 Several groups developed assays for oxidation-specific epitopes on plasma low-density lipoprotein (LDL). Two assays use antibodies against oxidized phospholipids 4,5 ; our assay uses the monoclonal antibody (mAb) 4E6 directed against an oxidation-dependent epitope in the apolipoprotein B-100 moiety of LDL. 6,7 It is generally believed that "fully oxidized LDL" does not exist in the circulation. Blood is rich in antioxidants. In addition, such highly oxidized particles would be rapidly cleared in the liver via scavenger receptors. 8 In contrast, circulating minimally oxidized LDL in which oxidative modification has not been sufficient to cause changes recognized by scavenger receptors was demonstrated. 9 Therefore, all assays for oxidized LDL presumably detect minimally oxidized LDL. This oxidized LDL is only a minor fraction of LDL ranging from 0.001% in healthy controls 10 to approximately 5% in patients with acute coronary events. 6 Because LDL is the substrate for oxidation , concentrations of oxidized LDL correlate with LDL concentrations, and in turn with the cholesterol within LDL. In addition, concentrations of oxidized