Objectives: Smoking is an important risk factor for metabolic syndrome (Mets) and cardiovascular disease. This study has been designed to investigate the relationship between smoking, metabolic syndrome, and arteriosclerosis among men in South Korea. Methods: We have retrospectively enrolled data of 5,103 men aged over 20 years, who underwent a health check-up including carotid ultrasonography in 2014. Smoking status and amount were collected from self-reported questionnaires. The diagnosis of Mets was made using criteria modified NCEP-ATP III. Using multivariate logistic regression analysis, the risk of Mets and arteriosclerosis defined as abnormal carotid intima-media thickness (CIMT) and carotid plaque according to smoking amounts was examined. Results: Both former (29.7%) and current (27.8%) smokers had a higher prevalence of Mets than never (23.2%) smokers [OR (95% CI): former, 1.35 (1.14, 1.6); current, 1.63 (1.35, 1.98), respectively]. There had been a significant increase in the risk of Mets, low HDL-cholesterol and high fasting blood sugar among the former and current smokers who smoke ≥20 pack-years (PY) (p<0.001). And there had also been a significant increase in the risk of high triglyceride at all levels in smoking amount. There was a clear dose-dependent relationship between smoking amount and arteriosclerosis especially the risk of carotid plaque (all p<0.005). In individuals without Mets, smoking consumption in former or current smokers was positively associated with the risk of CIMT and carotid plaque by adjusted age, BMI, LDL-cholesterol. Conclusions: The former or current smoking status and high level of smoking amount were relation with Mets and arteriosclerosis in men. The smoking was risk factor for arteriosclerosis and that was explained by relationship with metabolic syndrome in part.