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The metabolic syndrome (MetS) is a clustering of risk factors known to promote or increase the risk for development of diabetes mellitus and cardiovascular disease (CVD). Approximately one-third of the adult population of developed countries can be categorized as having MetS by different definitions. MetS, even in the absence of diabetes mellitus, is associated with an increased risk of CVD and total mortality. Those with diabetes mellitus are considered a cardiovascular risk equivalent and warrant aggressive management of underlying risk factors to optimize prevention of CVD. Initial evaluation of coronary heart disease risk involves global risk estimation using Framingham or other algorithms for risk prediction. Consideration of screening for novel risk factors such as C-reactive protein, as well as subclinical atherosclerosis (from carotid ultrasound, computed tomography, or ankle-brachial index), can further refine the estimation of future CVD risk. The presence of subclinical atherosclerosis or elevated levels of C-reactive protein can potentially modify recommended treatment goals for lipid and other cardiovascular risk factors. The American Heart Association and US National Heart Lung and Blood Institute have released guidelines for the clinical management of MetS, which focus on lifestyle management for abdominal obesity and physical inactivity, and clinical management of atherogenic dyslipidemia, elevated BP, elevated glucose, and prothrombotic state.