Article Summary Clinical Management of Metabolic Syndrome. Report of the American Heart Association/National Heart, Lung, and Blood Institute/American Diabetes Association Conference on Scientific Issues Related to Management. Grundy SM, Hansen B, Smith SC, Cleeman JI, Kahn RA. Circulation. 2004;109:551-556. Objective: To consider the issues of pathogenesis and presentation of metabolic syndrome and its underlying risk factors, to discuss unresolved issues and research challenges, and to examine clinical management. Observations: Metabolic syndrome presents in about 30% of the overweight adult US population, according to the Adult Treatment Panel III classification criteria, with Hispanics and south Asians particularly susceptible. Presenting characteristics include abdominal obesity, elevated triglyceride levels, reduced high-density lipoprotein levels, hypertension, and hyperglycemia. A number of additional components of the syndrome, which are not measured on a routine basis, include elevated apolipoprotein B, small low-density lipoprotein particles, insulin resistance and hyperinsulinemia, impaired glucose tolerance, elevated C-reactive protein levels, and variations in coagulation factors such as plasminogen activator inhibitor-1 and fibrinogen. Each of these components increases the risk for type 2 diabetes and cardiovascular disease. Conclusion: Various clinical guidelines emphasize the importance of risk reduction for CVD. Since all the components of metabolic syndrome increase risk for CVD and type 2 diabetes, more clinical attention is necessary for the treatment of metabolic syndrome.