Although the relationship between diabetes and cardio- vascular risk has long been recognized, it is increasingly clear that even in the absence of diabetes, insulin resistance is associated with a higher risk of cardiovascular disease. The metabolic syndrome (also called syndrome X) describes the coexistence of hyperinsulinemia, obesity (particularly cen- tral), glucose intolerance, hypertension, and dyslipidemia (including elevated triglyceride levels). More recently, asso- ciations have been appreciated between these abnormalities and other potential contributors to cardiovascular risk, in- cluding increased proportion of small dense low density lipoprotein (LDL) particles, increased plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator antigen (TPA Ag), TNF