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Objectives: We sought to determine whether Rho kinase (ROCK) activity is increased in a Taiwanese population with metabolic syndrome (MetS). Background: Recent studies suggest that ROCK may be involved in the pathogenesis of MetS, but clinical studies linking ROCK with MetS are lacking. Methods: We studied 40 Taiwanese subjects (60% men, mean age 55.5 ± 5.6 years) who were diagnosed with MetS with National Cholesterol Educational Program Adult Treatment Panel III criteria and 40 age- and gender-matched control subjects. Subject demographics were recorded, and blood samples were obtained. Results: Compared with control subjects, ROCK activity, as determined by phosphorylation of myosin binding subunit (MBS) in leukocytes, was greater in MetS subjects (mean phospho-MBS/MBS ratio 0.46 vs. 0.35, p = 0.002). A cutoff value for ROCK activity of 0.39 predicted the presence of MetS with specificity and sensitivity rates of 70%. Plasma high-sensitivity C-reactive protein was greater (5.5 mg/l, 95% confidence interval [CI] 3.1 to 7.2 mg/l vs. 2.8 mg/l, 95% CI 1.1 to 3.9 mg/l, p = 0.01) and adiponectin was lower (4.9 μg/ml, 95% CI 3.2 to 6.1 μg/ml vs. 5.9 μg/ml, 95% CI 4.2 to 7.5 μg/ml, p = 0.01) in MetS subjects compared with control subjects, but plasma levels of interleukin-6 and tumor necrosis factor-alpha were not different (p > 0.05 for both). Body mass index, waist circumference, fasting glucose, high-sensitivity C-reactive protein, and triglyceride levels were associated with increased levels of ROCK activity. The risk of increased ROCK activity increased with the number of MetS components (p for trend <0.001). Conclusions: Rho kinase activity is increased in Taiwanese subjects with MetS and is associated with each component of MetS and markers of inflammation. These findings suggest that ROCK activity may be a novel serological marker of MetS. [Copyright &y& Elsevier]