We investigated the association between the multiple metabolic risk factors and cardiovascular and overall mortality among Korean men, a population with a low prevalence of obesity. This prospective cohort study involved 682,597 Korean men, aged 30-69 years at baseline (1992), who were initially without cancer or debilitating diseases. Death due to ischemic heart disease (IHD), stroke, cardiovascular disease (CVD), and any cause among men relative to metabolic risk factors, including overweight, high blood pressure, high fasting glucose, and high total cholesterol was analyzed. There were 17,785 deaths during the 8.5-year follow-up, of which 874 were due to IHD, 1644 to stroke, and 3306 to CVD. As a function of the number of metabolic risk factors, the relative risk of death from CVD was 2.0 (1.7-2.2), 2.9 (2.5-3.3), 3.5 (3.0-4.1), and 5.0 (3.9-6.4) for 1, 2, 3, and 4 risk factors, respectively, whereas the relative risk of death from all causes was 1.3 (1.2-1.4), 1.5 (1.4-1.6), 1.6 (1.5-1.7), and 1.9 (1.6-2.2) for 1, 2, 3, and 4 risk factors, respectively. The relative risk of IHD, stroke, CVD and all-cause mortality increased linearly with the number of metabolic risk factors. Early identification and strict management of metabolic risk factors should be reinforced in Koreans, even though there is a low prevalence of obesity among this population.