BACKGROUND: The association between elevated levels of triglycerides and insulin may be weaker in African-American women than in women of other groups, leading to underdiagnosis of the metabolic syndrome (MetS) in African-American women when using the National Cholesterol Education Program (NCEP) criteria, as that criteria does not include a marker of insulin resistance, using elevated triglycerides to provide an indirect indication of insulin resistance. OBJECTIVES: To determine the degree of agreement between two definitions for the MetS, that described by the NCEP and the NCEP criteria with the addition of a marker of insulin resistance in a sample of African-American women. METHOD: This nonexperimental pilot study took place in the General Clinical Research Center of a major medical center Thirty-three African-American women 19-45 years of age were screened using the NCEP criteria for MetS, additional markers of insulin resistance, and a 2-hour Oral Glucose Tolerance Test. FINDINGS: Six (18%) women were classified as having the MetS using the NCEP criteria. When one of three markers for insulin resistance (hyperinsulinemia, acanthosis nirgricans, or Homeostatic Model Assessment Insulin Resistance) was added to the criteria, 15 (45.5%) to 19 (59.5%) of the women were then identified as having MetS. DISCUSSION: As identified in the literature, the prevalence of cardiovascular disease risk in African-American women may be underestimated based on the sole use of the NCEP criteria. Further because there is some evidence that insulin resistance develops before many other indicators, the addition of a marker of insulin resistance may assist in earlier identification of African-American women at high risk for cardiovascular disease.