The term metabolic syndrome refers to a virulent and lethal group of atherosclerotic risk factors, including dyslipidemia, insulin resistance, obesity, and hypertension. This syndrome affects some 47 million people in the United States, placing them at increased risk for coronary artery disease (CAD). Particularly prominent as a risk factor for development of heart disease is central obesity. Immediate treatment of the metabolic syndrome is essential because these patients quickly develop diabetes, CAD, and stroke. Treatment is a multifactorial process and includes diet, exercise, and pharmacologic therapy. The latter consists of statins, fibrates, angiotensin-converting enzyme inhibitors, and thiazolidinediones, all of which can decrease the risk and incidence of CAD.