Objective To investigate the expression of adipocyte fatty acid binding protein (FABP4) in the macrophages of elderly male patients with metabolic syndrome (MS). Methods A total of 108 elderly patients who were admitted in our hospital from January to October 2013 were enrolled in this study. According to being diagnosed as MS or not, they were divided into MS group (n=68) and non-MS group (n=40). Serum levels of interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), epidermal growth factor (EGF) and vascular endothelial growth factor (VEGF) were detected by enzyme-linked immunosorbent assay (ELISA). And serum level of high-sensitivity C-reactive protein (hs-CRP) was measured by immunoturbidimetric assay. After the peripheral blood monocytes were obtained by Ficoll density gradient centrifugation and adherence method, the monocytes were differentiated to macrophages. The expression of FABP4 in the macrophages was determined by Western blotting. SPSS statistics 16.0 was used to analyze the data. According to data type, Students’ t test or Chi-square test were adopted. Correlation between indices was analyzed by Pearson linear correlation analysis. Results Compared with the non-MS group, the serum levels of IL-6 [(105.7±17.1) vs(135.4±11.8)pg/ml], TNF-α [(20.60±6.19) vs(29.50±5.74)pg/ml], hs-CRP [(1.98±1.00) vs(3.54±1.12)mg/L] and VEGF [(130.8±19.9) vs(180.2±48.1)pg/ml], as well as the expression of FABP4 [(0.25±0.13) vs(0.36±0.10)] in the macrophages were significantly higher in the MS group (P<0.05). Correlation analysis showed that the FABP4 was positively correlated with VEGF (r=0.536), IL-6 (r=0.369), TNF-α (r=0.441), and hs-CRP (r=0.597, all P<0.05). Conclusion The protein level of FABP4 in the peripheral blood macrophages is high in the elderly male MS patients. FABP4 may be involved in the incidence and development of vascular endothelial impairments in MS patients, and the mechanism may be related to the inflammatory reaction and vascular endothelial dysfunction.