The metabolic syndrome (MetS) is a cluster of the most dangerous heart attack risk factors, and up to a quarter of the world’s adults might have MetS. In general, cardiovascular diseases (CVD) are the most common cause of death in the world. As most patients show no obvious symptoms prior to the first incident, identification of risk factors and early intervention are important. Hypercholesterolemia is a well-established strong risk factor and is a primary target for the prevention of CVD (Fig. 1, see chapter “Hyperlipidemia”). MetS has been identified as the second target. It was previously called syndrome X [1] and insulin resistance syndrome [2], as low insulin sensitivity occurs frequently in this condition (Fig. 1).