Approximately 2500 Americans die from cardiovascular disease (CVD) each day. Each year, CVD claims more lives than the next four leading causes of death combined. Direct and indirect costs of CVD are estimated to be Dollars 403.1 billion in 2006. Despite advancements in conventional therapy, the residual risk of CVD continues to rise. One component of the cardiometabolic risk is metabolic syndrome. Metabolic syndrome is a constellation of interrelated risk factors of metabolic origin including abdominal obesity, atherogenic dyslipidemia, elevated blood pressure, elevated plasma glucose level, and prothrombotic and proinflammatory states that promote atherosclerotic CVD and increase the risk of type 2 diabetes mellitus. Approximately 47 million residents of the United States have metabolic syndrome. Abdominal obesity and insulin resistance appear to be its predominant underlying risk factors. Abdominal adiposity is considered high-risk fat, and it is associated with insulin resistance, hyperglycemia, dyslipidemia, hypertension, and prothrombotic and/or proinflammatory states. Despite notable advances in cardiovascular risk management, the prevalence of cardiovascular events and type 2 diabetes remains high. First-line therapy for individuals with metabolic syndrome should be directed to the major CVD risk factors, namely, elevated low-density lipoprotein cholesterol levels, hypertension, and diabetes, and it should emphasize lifestyle modification. Until additional research better defines the most appropriate therapies, conventional cardiovascular risk factors, such as lipid levels, blood pressure, and diabetes, should be managed in individuals with metabolic syndrome according to nationally accepted clinical guidelines.