The metabolic syndrome is a clustering of risk factors known to promote or increase the risk of diabetes development and subsequent cardiovascular disease. Screening for subclinical atherosclerosis using new imaging technologies or novel biomarkers could help to further risk-stratify patients with metabolic syndrome. In particular, noninvasive imaging of carotid intima-media thickness and coronary artery calcium scoring seem to have promising prognostic value in identifying patients at high risk. Early identification could lead to improved patient or physician adherence to risk-reducing behaviors or interventions and improve clinical outcomes.