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Objective: This study aimed to evaluate factors that affect adherence in individuals at high risk of metabolic syndrome, with a focus on knowledge and attitude effect. Subjects and Methods: A sample of 900 high-risk individuals with metabolic syndrome was recruited in this cross-sectional study. During the study period, all participants filled in validated structured questionnaires to evaluate the adherence to different management options of metabolic syndrome, knowledge about the syndrome, and health-related attitude. Simple linear regression followed by multiple linear regression analysis were used to evaluate the effect of knowledge, attitude, and other factors on participants' adherence to both medications and lifestyle changes. Results: Of the 900 participants, 436 (48.4%) were nonadherent to medications and 813 (90.3%) were nonadherent to lifestyle changes. Increasing age (r = 0.140 …