Introduction: The detection of preclinical changes in Left Ventricular (LV) structure in the Metabolic Syndrome (MetS) has not been adequately studied, although MetS is strongly associated with increased cardiovascular risk. The influence of the MetS and its individual components on LV geometry across age groups in a cohort of SA Indians was studied. Method: Data on 902 randomly selected participants, a sub-group of the Phoenix Lifestyle project was studied. Detailed methodology has been previously published. The MetS was defined according to the harmonised criteria, hypertension according to the JNC criteria, diabetes according to the American Diabetes Association criteria and echocardiography according to the European Society of Echocardiography guidelines. Results: Normal LV geometry was found in 80.8%, eccentric hypertrophy 15.9%, concentric hypertrophy 3.2%, concentric remodelling 0.5%. Logistic regression with MetS as the only independent variable strongly predicted the presence of both concentric (OR = 4.36 CI 1.84, 10.3 p<0.0001;) and eccentric hypertrophy (OR = 3.15 CI 2.15, 4.62; p=0.001). When all MetS component risk factors were adjusted for each other, independent predictors for the eccentric hypertrophy were the waist circumference (p=0.002; OR= 2.95 CI 1.49, 5.84), fasting glucose (p= 0.021; OR= 1.7 CI 1.1, 2.7) and Blood Pressure (BP) (p=0.005; OR= 1.78 CI 1.19; 2.71). Conclusion: The MetS is not associated with any additional risk for LV remodelling beyond its individual risk factor components. The main determinants of LV remodelling appear to be mediated by the effects of the increased waist circumference, increased blood glucose and BP.