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A number of important cardiovascular risk factors tend to cluster in a pattern that has been described by some as metabolic syndrome. Although controversy persists regarding whether cardiovascular risk due to these factors is additive or synergistic, their clinical importance is growing. This animation discusses some of the metabolic derangements that underlie metabolic syndrome. (From P Libby: Changes and challenges in cardiovascular protection: A special CME activity for physicians. Created under an unrestricted educational grant from Merck & Co., Inc. Copyright © 2002, Cardinal Health; used with permission.)