The aim of the study was to identify the effect of vegetative nervous dysfunction on the level of cardiovascular risk in persons with metabolic syndrome undergoing intensive monitoring. The survey involved 750 civil servants aged 35 to 70 years, including 476 men and 274 women. Diagnosis of the metabolic syndrome (MS) was carried out according to the IDF and AHA / NHLBI consensus criteria (2009). The investigation of the state of vegetative nervous regulation of hemodynamics was carried out by means of variational intervalometry. As the "end points" of the study, any form of acute coronary syndrome, acute impairment of cerebral circulation or other forms of peripheral arterial blood flow disturbance during the study period was considered. Statistical analysis was carried out using the Pearson's χ2 criterion the two-sided Fisher exact test and two-sided Dannet t-criterion. The frequency of metabolic syndrome in the group was 40.3%. Vegetative nervous dysfunction (VND) was detected in 45.6% of cases. The frequency of combinations of metabolic syndrome and VND was 21.7% and significantly exceeded the expected with an independent distribution of these pathological conditions. A significant excess of the frequency of development of acute violations of the regional circulation in the group of the presence of a combination of metabolic syndrome and autonomic dysfunction was observed over those surveyed with the absence of these pathological conditions. Significant differences were revealed by the results of the observation of the combination group of MS and VND in comparison with all the others: VND without MS (χ2 = 4.92, p = 0.046); MS without VND (χ2=4.26, p = 0.057); absence of MS and VD (χ2 = 8.35, p = 0.022). Between groups of patients without a combination of syndromes, no significant differences were revealed. Thus, autonomic dysfunction can be a factor associated with metabolic syndrome and modifying the risk of cardiovascular complications in the direction of its increase.