The metabolic syndrome (MetS) is associated with a higher risk for both, type 2 
diabetes mellitus and cardiovascular disease. The cornerstone of treatment is 
lifestyle modification, encompassing weight reduction and physical exercise. 
However, pharmacotherapy is usually also required to achieve the recommended 
target values for the various components of the MetS, such as hypertension, 
dysglycemia and dyslipidemia. Regarding lipid treatment, statins are the main 
therapeutic agents while in blood pressure control a significant amount of 
pathophysiological and clinical evidence would suggest the use, as first line 
agents, of ACE inhibitors or angiotensin receptor blockers. Metformin seems to 
be the drug of choice for dysglycemia, specially since recent evidence questions 
the safety of thiazolidinediones. New drugs, targeting multiple components of 
the MetS, are under development but no data are currently available regarding 
their long-term efficacy and safety profile. In general, a multifactorial 
approach is recommended to decrease cardiovascular risk in patients with the 
MetS.