This review provides an update on the metabolic syndrome and prediabetes. Compared to the downstream disorders, namely type 2 diabetes and cardiovascular disease (including coronary artery disease, cerebrovascular disease and peripheral vascular disease), prediabetes and the metabolic syndrome represent intermediate cardiometabolic states. The generally accepted working definitions, epidemiology, pathophysiology and clinical relevance of these intermediate conditions are discussed. Importantly, the review focuses on evidence-based strategies for preventing the cardiometabolic sequelae associated with prediabetes and the metabolic syndrome. The importance of lifestyle modification in the primary prevention of the metabolic syndrome and prediabetes is emphasized, and the interaction between genetics and lifestyle intervention in predicting outcomes is presented. In addition to discussing the evidence from landmark clinical trials, we identify methods for translating the success achieved in clinical trials to the community with regard to the prevention of diabetes and cardiometabolic risk. Future research needs are also highlighted. The overall goal is to foster an increased understanding of the prominent role of primary prevention in stemming the tide of cardiometabolic disorders in the society.