Background: The association between elevated levels of triglycerides and insulin may be weaker in African American women (AAW) than in women of other groups, leading to underdiagnosis of the metabolic syndrome (MetS) in AAW when using the National Cholesterol Education Program (NCEP) criteria, as those criteria do 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 AAW. Method: This nonexperimental pilot study took place in the General Clinical Research Center of a major medical center. Thirty-three AAW 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 nigricans, 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 AAW 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 AAW at high risk for cardiovascular disease.