Metabolic syndrome is characterized by a clustering of cardiovascular and metabolic risk factors. This syndrome is now widely recognized as a distinct pathologic entity. It is receiving a great deal of attention in the medical literature and also in the lay press. People with metabolic syndrome have a clustering of the following risk factors, including detrimental changes in glucose tolerance and insulin resistance, abdominal (visceral) obesity, atherogenic dyslipidemia, and hypertension. Metabolic syndrome is associated with important cardiovascular and cerebrovascular and metabolic risks. Prevention and treatment are therefore of great importance. Preventive measures involving lifestyle are mandatory. In addition, metabolic syndrome patients will require pharmacologic treatment, usually for the rest of their lives. Complex patterns of drug treatment are required. This review provides an extensive and critical review of the drug treatment of this complex pathologic entity.