The main results of this study regarding the MetS group and the tertile MetS Severity-Z score subgroups are as follows: (a) serum endocan levels were significantly elevated in the MetS tertile 3 subgroup compared to tertile 1 by approximately two-fold (Table 2); (b) additional endothelial factors (sICAM-1 and sVCAM-1) also exhibited significant increases and were significantly associated with endocan levels in the study groups (Table 2 and Figure 2). This evidence concerns the gene ESM1 and metabolic syndrome.