Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors. However, rather than using a dichotomous scale, a continuous metabolic syndrome (cMetS) score has been proposed to evaluate MetS because current MetS criteria do not function well in identifying those at high risk of cardiovascular mortality. The objective of this study was to examine the association between cMetS score and vascular mortality among Korean population. We included 441 411 individuals who visited health promotion centers and were given a medical examination from 1994 to 2004. MetS status, sum of MetS components, and cMetS score were calculated. The individuals with MetS had a higher hazard ratio (HR) for mortality from atherosclerotic vascular disease (HR = 1.54, 95% CI = 1.42-1.67), ischemic heart disease (HR = 1.74, 95% CI = 1.51-2.01), and total stroke (HR = 1.44, 95% CI = 1.28-1.62) when compared with those without MetS. Graded, strong associations between cMetS score and vascular mortality, particularly from ischemic heart disease and ischemic stroke, were observed. Subjects with a cMetS score ≥30 were at about 64 times greater risk for vascular mortality than those with a cMetS score below 0. cMetS score can be used to predict the risk of vascular death and provides a useful guideline to identify individuals at high risk for metabolic syndrome among Koreans.