● Atherogenic dyslipidemia manifests in routine lipoprotein analysis by raised triglycerides and low concentrations of HDL cholesterol. A more detailed analysis usually reveals other lipoprotein abnormalities, eg, increased remnant lipoproteins, elevated apolipoprotein B, small LDL particles, and small HDL particles. All of these abnormalities have been implicated as being independently atherogenic.● Elevated blood pressure strongly associates with obesity and commonly occurs in insulin-resistant persons. Hypertension thus commonly is listed among metabolic risk factors. However, some investigators believe that hypertension is less “metabolic” than other metabolic-syndrome components. Certainly, hypertension is multifactorial in origin. For example, increasing arterial stiffness contributes significantly to systolic hypertension in the elderly. Even so, most conference participants favored inclusion of elevated blood pressure as one component of the metabolic syndrome.

● Insulin resistance is present in the majority of people with the metabolic syndrome. It strongly associates with other metabolic risk factors and correlates univariately with CVD risk. These associations, combined with belief in its priority, account for the term insulin resistance syndrome. Even so, mechanisms underlying the link to CVD risk factors are uncertain, hence the ATP III’s classification of insulin resistance as an emerging risk factor. Patients with longstanding insulin resistance frequently manifest glucose intolerance, another emerging risk factor. When glucose intolerance evolves into diabetes-level hyperglycemia, elevated glucose constitutes a major, independent risk factor for CVD.