We thank Dr. Kawada for his interest in our recent article, in which we reported a positive association between metabolic syndrome (MetSyn) and carotid intima media thickness (IMT) in female police officers. In his letter, Dr. Kawada raised the question as to whether this association could be related to occupational factors. This is certainly an interesting proposal; yet, answering this question is complex as it requires consideration of numerous factors. In our study, we cite the work of others who have reported results similar to our study. Kawada states that the age and occupation of the subjects in these studies were varied and raises the question regarding the potential effect of occupational factors. The studies by Iglseder et al (age range, 40 to 65), Nishida et al (age range, 40 to 59), and Lin et al (age range, 15 to 87) have cohorts with similar age ranges as our study population (age range, 21 to 66). Regarding occupation, these four studies were large community-based studies without focus on occupation, which is different from our study. Participants in our study were all active duty police officers serving a large urban area in the northeastern United States. To some degree, all participants were exposed to various workplace factors, some of which are unique to policing including psychological stress, shift work, long work hours, the potential for violent confrontations, and environmental contaminants (eg, particulate matter, firearm cleaning solvents, noise from radio transmissions). To suggest that the positive relationship found between MetSyn and carotid IMT in female police officers in our study is due to occupational factors is difficult to discern since it cannot be tested statistically and was not a central focus of our study. Yet, we did raise this in our discussion as one potential mechanism for the positive association in female police officers with the caveat that future research is necessary to examine the effects of occupational factors.