Background and epidemiology: The metabolic syndrome refers to a constellation of clinical factors associated with an increased risk of diabetes and coronary artery disease. These factors include abdominal obesity, hypertension, dyslipidemia, impaired glucose metabolism, prothrombotic state and proinflammatory state. Also called the dysmetabolic syndrome, syndrome X or insulin resistance syndrome, this condition entered the scientific lexicon about 15 years ago as investigators sought to understand the link between insulin resistance and other metabolic factors in the development of coronary artery disease. Consistent, comprehensive results accumulated since then have not only confirmed that this syndrome leads to heart disease, but they have also demonstrated that modest interventions, such as changes in diet and physical activity level, may effectively control this syndrome and prevent outcomes such as diabetes. The rising prevalence of this syndrome in industrialized nations has largely been attributed to lifestyle changes in diet and physical activity, leading to higher obesity rates. In 2002 analysis of data from the Third National Health and Nutrition Examination Survey collected between 1988 and 1994 indicated that a whopping 44% of the American population aged 50 years and older had the metabolic syndrome, according to NCEP definitions.2 The prevalence increased with age, elevated body weight and membership in certain ethnic populations such as Hispanics and Native Americans. Additional research indicated that the syndrome was associated with a tripling of cardiovascular disease mortality and a doubling of overall mortality in a cohort of middle-aged Finnish men.3 Given that more than 40% of adults over age 50 are estimated to have this syndrome,2 these results have tremendous implications for future disease burden related to diabetes and coronary artery disease.