A cluster of factors, rather than one disease
Metabolic syndrome describes a combination of abnormalities that often occur together: abdominal adiposity, raised blood pressure, high triglycerides, low HDL cholesterol and altered glucose regulation. The label can help identify people who need a comprehensive assessment, but it does not replace diagnosis of each condition or an individual cardiovascular risk estimate.
How the classic syndrome is recognised
Under the widely used harmonised definition, at least three of the following five components identify metabolic syndrome. These remain descriptive criteria; they are not a universal treatment target.1
| Component | Criterion |
|---|---|
| Waist circumference | Increased according to population- and country-specific thresholds. |
| Triglycerides | At least 150 mg/dL (1.7 mmol/L), or treatment for elevated triglycerides. |
| HDL cholesterol | Below 40 mg/dL in men or 50 mg/dL in women, or specific treatment for reduced HDL. |
| Blood pressure | Systolic at least 130 mmHg or diastolic at least 85 mmHg, or antihypertensive treatment in someone with a history of hypertension. |
| Fasting glucose | At least 100 mg/dL, or treatment for elevated glucose. |
The blood pressure component of this definition should not be confused with the diagnostic classification of hypertension.
What the 2026 CKM framework adds
The 2026 AHA/ACC/ADA/ASN guideline addresses cardiovascular-kidney-metabolic (CKM) syndrome, a broader framework connecting metabolic risk, chronic kidney disease and cardiovascular disease. It promotes earlier identification, stage-based assessment and coordinated care. The classic three-of-five metabolic syndrome definition and CKM staging are related concepts, not interchangeable diagnoses.2
Visceral fat, the kidneys and the liver
Visceral fat is metabolically active and is often associated with insulin resistance, lipid abnormalities and low-grade inflammation. Body weight alone does not capture this risk: waist circumference, activity and accompanying illnesses provide additional information.
Assessment may include glucose or HbA1c, a lipid profile, estimated glomerular filtration rate and the urine albumin-to-creatinine ratio. Liver assessment may be appropriate when metabolic dysfunction–associated steatotic liver disease (MASLD) is suspected. The 2026 CKM framework emphasises assessment of both kidney filtration and albuminuria, rather than relying on serum creatinine alone.2
Reducing risk
A balanced diet, physical activity adapted to the individual, adequate sleep, avoiding tobacco and addressing excess weight can improve several components. Medicines are selected for the conditions actually present, such as hypertension, dyslipidaemia, diabetes or obesity, and for demonstrated cardiovascular or kidney benefit where indicated. No single medicine treats the entire classic syndrome.2,3
Cardiovascular risk and SCORE2 · Understanding hypertension
Related cardiovascular guides
Explore cardiovascular risk assessment, hypertension and coronary artery disease. These guides place individual measurements in the wider context of prevention.
About Massimo Fioranelli · Cardiology and internal medicine · Clinical practice at Sanatrix, Rome
References
- Alberti KGMM, et al. Harmonizing the metabolic syndrome. Circulation. 2009;120:1640–1645. doi:10.1161/CIRCULATIONAHA.109.192644.
- AHA/ACC/ADA/ASN. Guideline for the Prevention, Detection, Evaluation, and Management of Cardiovascular-Kidney-Metabolic Syndrome. 2026.
- American Diabetes Association. Standards of Care in Diabetes—2026.
English edition and scientific review: 23 October 2026. Educational information; individual assessment remains essential.