The association of lifetime alcohol drinking pattern with the prevalence of the metabolic syndrome is largely unknown. Analyses were conducted on a population-based sample in a cross-sectional study (N=2818, ages 35-79 years, 93% whites). Included were subjects who drank at least once a month for a period of at least six months during their lifetimes and were free of cardiovascular disease and cancer at the time of interview. Lifetime drinking measures included total years of drinking, total drinking days, volume (total drinks) and average intensity (#drinks/drinking day); frequency of intoxication and heavy drinking; and age drinking began and ended. Metabolic syndrome components included impaired fasting glucose (IFG), high triglycerides (HTG), low HDL cholesterol (LHDLC), abdominal obesity (ABO), and hypertension (HBP). Potential confounders examined were age, gender, race, family history of coronary heart disease or diabetes, years of education, lifetime and current cigarette smoking, current drinking status, physical activity, and dietary factors. Multiple logistic regressions indicated that average intensity was directly related to IFG, HTG, HBP, and metabolic syndrome overall (p for linear trend=0.03, 0.04, 0.003, and 0.009, respectively) and to ABO in women only (p for trend=0.0004). Prevalence ratios (95% CI) for the metabolic syndrome according to quartiles of intensity were 1.00 (lowest), 1.23 (0.91-1.67), 1.43 (1.06-1.91) and 1.60 (1.12-2.30). Total drinking days was inversely related to LHDLC (p for trend=0.0002) and to ABO in women only (p for trend<0.0001). It is concluded that lifetime drinking patterns are significantly related to the prevalence of the metabolic syndrome.