The metabolic syndrome is characterized by metabolic and cardiovascular disorders, including obesity, hypertension, impaired glucose tolerance and dyslipidemia. Recently, metabolic syndrome has been associated with a greater risk of atherosclerotic cardiovascular disease than any of its individual components. Its pathophysiology seems to be largely due to insulin resistance and visceral adiposity, leading to a proinflammatory and prothrombotic milieu that potentiates atherosclerosis. Recent knowledge implies a role for fat-derived "adipokines," as pathogenic contributors or protective factors. Furthermore, low plasma levels of ghrelin, an orexigenic peptide that promotes a positive energy balance, have been associated with the presence of vascular damage in patients with metabolic syndrome.