PURPOSE OF REVIEW: Novel research over the past 2 years has necessitated an update of our 'ABCDE' approach to the metabolic syndrome. RECENT FINDINGS: Clinical trials investigating the role of aspirin in primary prevention have led to an adjustment in the indication for aspirin in metabolic syndrome patients at intermediate risk of a cardiovascular event. There has been renewed enthusiasm for the use of niacin as second-line treatment for atherogenic dyslipidemia, with fibrates reserved for those with severe residual dyslipidemia. In light of the noteworthy findings of the Justification for the Use of statins in Primary Prevention: an Intervention Trial Evaluating Rosuvastatin trial, the 'C' category representing 'cholesterol' has been expanded to include the use of high-sensitivity C-reactive protein for guiding statin use and perhaps monitoring statin therapy. Recent evidence confirms that diet and exercise continue to be the cornerstone of any metabolic syndrome treatment strategy. SUMMARY: The revised 'ABCDE' approach incorporates the most recent influential studies into a simple yet thorough algorithm for management of the metabolic syndrome.