The clustering of several disorders associated with increased risk of cardiovascular disease has been recognised for over 80 years,1making claims that the drug industry invented the syndrome lack credibility. However, the modern concept of the metabolic syndrome started in 1988 with Reaven describing the clustering of insulin resistance, hyperinsulinaemia, glucose intolerance, hypertension, raised triglyceride concentration, and low high density lipoprotein cholesterol concentration.2 Over the next decade other features, most notably central obesity, were found to be associated with this cluster. There was little argument about the existence of the clustering but confusion about its diagnosis. Different criteria abounded, the most widely used coming from the World Health Organization3 and the National Cholesterol Education Programme (adult treatment panel III).4 The International Diabetes Federation then brought the various groups together recommending a diagnostic set5 which was similar to the updated version …