The metabolic syndrome represents a cluster of closely connected premorbid risk 
factors or diseases with visceral obesity type 2 diabetes, hypertension and low 
HLD/hypertriglyceridemia as established traits affecting about 20% in the adult 
European populations. This syndrome develops on a complex soil with 
overnutrition, low physical activity and psychosocial stress. Common 
comorbidities are fatty liver, sleep apnoe and endothelial dysfunction with 
cardiovascular complications, nephropathy and type 2 diabetes as "end-stage" 
diseases. Thus, a rational diagnostic is needed to elucidate the complex cluster 
of diseases as basis for an integrated therapy. There is a clear priority for 
life style intervention, however, most diseases of the metabolic syndrome need 
medical treatment. Medical treatment of single traits has to take into account 
possible pleiotropic or adverse effects on the other traits. This paper presents 
the pros and cons of major drug intervention for type 2 diabetes, hypertension, 
dyslipidemia and hypercoagulation in the context with the metabolic syndrome.