Metabolic and non metabolic cardiovascular risk factors tend to cluster in the 
same individual. The association of the cardiovascular risk factors is referred 
as metabolic syndrome (MS). This syndrome is associated with an increased risk 
of accelerated atherosclerosis and cardiovascular events. The cluster of 
cardiovascular risk factors of the MS includes: insulin resistance with or 
without glucose intolerance or diabetes, abdominal obesity, atherogenic 
dyslipidemia, elevated blood pressure, a proinflammatory and prothrombotic 
state. MS is one of the major issues in the management of cardiovascular disease 
because of its epidemic proportion and its impact on increasing risk of 
developing both cardiovascular disease and type 2 diabetes. The main therapeutic 
goal in the management of patients with the MS is to reduce risk for clinical 
cardiovascular events and to prevent type 2 diabetes. In particular, for 
individuals with established diabetes, risk factors management must be 
intensified to reduce their higher cardiovascular risk. Lifestyle changes have a 
critical role in the clinical management of the risk factors predisposing to MS, 
such as overweight/obesity, physical inactivity. A large body of evidence 
suggests the use of Metformin and Acarbose for the treatment of the syndrome as 
these drugs have consistently shown to reduce cardiovascular events and 
mortality. Most anti-hypertensive drugs have unfavorable metabolic profile while 
b-blockers, centrally acting agents and drugs targeting the renin angiotensin 
system should always be considered for the treatment of hypertension in patients 
with MS.