Genetic study on metabolic syndrome is a great challenge, due to its complex traits and the pleiotropic manifestation of atherosclerosis. Familial aggregation and recurrence risk ratio can provide the insight of possible genetic mechanism. The Chin-Shan community family study was based on adolescent probands and their relatives (1356 subjects) who were recruited from one junior high school in the community. Structured questionnaires and biochemical measures were obtained in standard procedures. Definition of metabolic syndrome was followed using the criteria defined by the third adult treatment panel, with a modification of the criteria for adolescent and Asian population. Grandmothers had the highest frequencies (70%) in metabolic syndrome and various atherosclerotic risks. Three factors were found and thus explained 68% of the overall variance. Estimated heritability was the highest in LDL and cholesterol factor (0.36 and 0.40), then blood pressure/obesity factor (0.27), and insulin resistance/dyslipidemia (0.27). Recurrence risk ratio among siblings was 2.95 (95% confidence interval [CI]: 1.39-6.26). The adjusted odds ratio (OR) of proband's metabolic syndrome status was 1.99 (95% CI: 1.08-3.66). The adjusted odds ratios for the three factors for predicting metabolic syndrome were all significant, with highest risk in blood pressure/obesity factor (OR: 1.27, CI: 1.22-1.33), then insulin resistance/dyslipidemia (OR: 1.29, CI: 1.16-1.23). This study demonstrated clearly familial aggregation and recurrence risk ratio of metabolic syndrome and components among the general ethnic Chinese population in Taiwan.