Systematic population screening to pick out the patients suffering from Metabolic Syndrome, for instance from a certain age group, would be difficult to carry out and above all very costly.

But, as recently demonstrated in Canada, it can be extremely easy to spot these patients: all that is required is a measurement of their waist and blood triglycerides. In tests, this predictive diagnostic tool was able to identify more than 80 % of the patients suffering from Metabolic Syndrome.

The concept of Metabolic Syndrome has now been identified. The cardiovascular threat it poses is now clearly recognised, and - something new - a simple diagnostic tool is available. We must now address the issue of how these patients should be treated.

We know how to treat patients suffering from diseases corresponding to conventional diagnostic criteria and located above the water-line in our iceberg picture. Several recently developed drug categories have improved treatment efficacy and safety. Also, we now know how these drugs can best be used, and recommendations have been issued, often through international consensus. However, further progress can certainly be made, particularly as concerns treatment compliance.

But as seen in the first graph, this conventional approach has probably reached its limit. The issue is therefore to manage the immersed part of the iceberg, i.e. Metabolic Syndrome, and thereby attempt to reduce significantly its impact in terms of disability and cardiovascular mortality.

Some lifestyle and dietary rules are essential: more physical exercise and a more balanced diet; but changing life-long habits is extremely difficult. Such a change may require an entire generation or even two.

The pharmacological approach must therefore be investigated: some drugs already available have shown that they are able to affect one of the relevant parameters (statins on cholesterol, glitazones on sugar, antihypertensives on blood pressure, etc.); others are able to affect two parameters (fibrates on cholesterol and triglycerides), but the optimal manner in which these existing drugs should be used in patients with Metabolic Syndrome (doses, treatment regimens, combinations) has yet to be fine-tuned and new responses should be found.

It is therefore crucial to conduct supplementary fundamental and clinical research to halt the spread of this epidemic, improve our knowledge of the populations affected, gain a more in-depth knowledge of the physio-pathology of Metabolic Syndrome and develop new pharmacological treatments and evaluation methods.