The prevalence of the metabolic syndrome among developed countries is rising, and this is largely driven by increasing obesity rates. Central obesity plays a key role in the pathogenesis of the metabolic syndrome: it promotes inflammation, hypertension and dyslipidaemia, and leads to the development of type 2 diabetes mellitus and atherosclerosis. Clinical management should be focused on multifactorial intervention to address all the associated cardiovascular risk factors. The atherogenic mixed dyslipidaemic profile associated with the metabolic syndrome is an important target for intervention to reduce the risk of type 2 diabetes and premature cardiovascular disease.