Metabolic syndrome (MetS) is a bunch of interconnected metabolic abnormalities, including central obesity, insulin resistance, dyslipidemia, hypertension, and chronic systemic inflammation. These interrelated conditions significantly increase the risk of type 2 diabetes mellitus, cardiovascular disease, and nonalcoholic fatty liver disease. This chapter examines the intricate pathophysiological mechanisms underlying MetS, including insulin signaling defects, adipose tissue dysfunction, dyslipidemia, oxidative stress, and mitochondrial impairment. It further outlines current and emerging therapeutic strategies, including dietary and physical activity interventions, pharmacologic agents (e.g., metformin, statins, GLP-1 receptor agonists), and novel approaches targeting gut microbiota and metabolic inflammation. A precision medicine approach, integrating genomics and digital health, is highlighted as the future direction in managing MetS. Understanding these mechanisms holistically is essential to designing effective preventive and therapeutic interventions to combat this global health challenge.