<span class="paragraphSection"><div class="boxTitle">Abstract</div>Ambient air pollution and temperature have been linked with cardiovascular morbidity and mortality. Metabolic syndrome and its components—abdominal obesity, elevated fasting blood glucose concentration, low high-density lipoprotein cholesterol concentration, hypertension, and hypertriglyceridemia—predict cardiovascular disease, but the environmental causes are understudied. In this study, we prospectively examined the long-term associations of air pollution, defined as particulate matter with an aerodynamic diameter less than or equal to 2.5 µm (PM<sub>2.5</sub>), and temperature with the development of metabolic syndrome and its components. Using covariate-adjustment Cox proportional hazards models, we estimated associations of mean annual PM<sub>2.5</sub> concentration and temperature with risk of incident metabolic dysfunctions between 1993 and 2011 in 587 elderly (mean = 70 (standard deviation, 7) years of age) male participants in the Normative Aging Study. A 1-μg/m<sup>3</sup> increase in mean annual PM<sub>2.5</sub> concentration was associated with a higher risk of developing metabolic syndrome (hazard ratio (HR) = 1.27, 95% confidence interval (CI): 1.06, 1.52), an elevated fasting blood glucose level (HR = 1.20, 95% CI: 1.03, 1.39), and hypertriglyceridemia (HR = 1.14, 95% CI: 1.00, 1.30). Our findings for metabolic syndrome and high fasting blood glucose remained significant for PM<sub>2.5</sub> levels below the Environmental Protection Agency's health-safety limit (12 μg/m<sup>3</sup>). A 1°C increase in mean annual temperature was associated with a higher risk of developing elevated fasting blood glucose (HR = 1.33, 95% CI: 1.14, 1.56). Men living in neighborhoods with worse air quality—with higher PM<sub>2.5</sub> levels and/or temperatures than average—showed increased risk of developing metabolic dysfunctions.</span>
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