The metabolic syndrome: Syndrome X "reloaded" Metabolic syndrome (Syndrome X "reloaded") is a unique clustering of clinical syndromes and metabolic derangements. Reaven initially described the MS in 1988. He initially discussed the four major determinants consisting of: I. Hypertension. II. Hyperinsulinemia. III. Hyperlipidemia (Dyslipidemia of elevated VLDL – triglycerides, decreased HDL-cholesterol, and elevated small dense atherogenic LDL-cholesterol). IV. Hyperglycemia or glucose intolerance. He also emphasized the importance of insulin resistance being central to the development of coronary artery disease or CHD. Since that time numerous papers and authors have added several associated findings to the MS and additionally several other names have been given to describe this clustering phenomenon. The important association of polycystic ovary syndrome (PCOS), hyperuricemia, fibrinogen, hsCRP, microalbuminuria, PAI-1, and the more recently added asymmetrical dimethyl arginine (ADMA), reactive oxygen species (ROS) and now the damaging oxidative potential of Hcy and endothelial dysfunction have all contributed to a better understanding of this complicated clustering phenomenon. The red boxes (ROS, Hcy, ADMA, and hsCRP) indicate the newer additions giving rise to the new terminology: Metabolic Syndrome Reloaded.