Previous research focused primarily on static metabolic syndrome (MetS) status, with less discussion on the effects of its dynamic changes on cardiovascular diseases (CVD), stroke, and all-cause mortality. This study examines the impact of MetS status changes on these health outcomes. This study used data from two prospective cohorts: the China Longitudinal Study of Health and Retirement (CHARLS) and the Wuhan Elderly Health Examination Center community (WEHECC). MetS was determined using the ATP III criteria. Participants were classified based on changes in MetS status, defined as MetS-free, MetS-recovery, MetS-developed, and MetS-chronic, assessed at baseline and at follow-up (three years later for CHARLS and six years later for WEHECC cohort). The primary outcomes for CHARLS included all-cause mortality, physician-diagnosed CVD, and stroke, while WEHECC cohort focused solely on all-cause mortality. Logistic regression models were utilized to calculate the odds ratios (ORs) and 95% confidence intervals (95% CI). Over the follow-up period from 2015 to 2018 in CHARLS, 335 participants (7.1%) developed CVD, and 237 (5.1%) experienced a stroke. Relative to the MetS-free group, individuals with MetS-chronic displayed higher risks of CVD (OR, 1.63 [95% CI, 1.25 to 2.13]) and stroke (OR, 2.95 [95% CI, 2.11 to 4.15]). In the WEHECC cohort, 40 participants died by 2022, with the MetS-chronic group showing a increased risk of all-cause mortality (OR, 2.76 [CI, 1.03 to 7.39]). Changes in MetS status are associated with different risks of CVD, stroke, and mortality, with chronic MetS significantly increasing these risks compared to MetS-free.