Abstract: Objective To study the correlation between metabolic syndrome(MS) and carotid artery intima-media thickness(CAIMT) in pilots. Methods MS in 1 032 pilots on active service at the age of 23-51 years (mean 33.32±8.47 years) was assessed according to the International Diabetes Federation (IDF) criteria with its incidence estimated. Sixty-four pilots, randomly selected from the 1 032 pilots, were divided into MS group (n=32) and non-MS group (n=32). Their CAIMT was measured. Results The incidence of MS was 4.84% in pilots. The CAIMT was significantly higher in MS group than in non-MS group(P＜0.05). The age, BMI, waist circumference(WC), blood pressure(BP), and serum fasting glucose level were significantly different between those with their CAIMT ≥ 0.9 mm and those with their CAIMT＜0.9 mm (P＜0.05). Logistic regression analysis showed that the WC was closely related with the CAIMT (P＜0.05). Conclusion The incidence of MS in pilots on active service is 4.84%. The MS is closely related with the CAIMT. WC is an independent risk factor for CAIMT in pilots.