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Abstract: Objective: We evaluated the impact of metabolic syndrome (MetS) defined by various criteria on the occurrence of ischemic stroke subtypes in a general Japanese population. Methods: A total of 2452 residents of a Japanese community, Hisayama, aged 40 years or older, were followed up for 14 years. To define MetS, we used the original Japanese criteria, the modified Japanese criteria, the International Diabetes Federation (IDF) criteria, the original National Cholesterol Education Program''s Adult Treatment Panel III (NCEP) criteria, and the modified NCEP criteria. We substituted a waist circumference of ≥90cm in men and ≥80cm in women for the values of ≥85cm and ≥90cm, respectively, in the modified Japanese criteria and for >102cm and >88cm, respectively, in the modified NCEP criteria. Results: Only MetS defined by the modified Japanese criteria showed a significant association with the development of lacunar infarction, and its hazard ratios (HRs) for the development of atherothrombotic and cardioembolic infarction were significant and greater than those of MetS defined by the other criteria: adjusted HRs for lacunar, atherothrombotic and cardioembolic infarction were 1.94 (95% confidence interval (CI), 1.13–3.32; P =0.02), 2.55 (95% CI, 1.25–5.18; P =0.01) and 3.94 (95% CI, 1.89–8.22, P <0.001), respectively, after adjustment for confounding factors. Conclusion: Our findings suggest that MetS defined by the Japanese criteria with the modification of a waist circumference of ≥90cm in men and ≥80cm in women is a better predictor of each ischemic stroke subtype in the Japanese population. [Copyright &y& Elsevier]