Improving clinical outcomes in patients at high risk for coronary heart disease (CHD) requires a multimodal approach, especially in patients with the metabolic risk factors that constitute the metabolic syndrome, which is associated with an elevated risk of CHD at all levels of low-density lipoprotein cholesterol (LDL-C). Achieving optimal clinical outcomes requires a comprehensive and aggressive therapeutic plan that includes pharmacotherapy and lifestyle changes. Effective pharmacotherapy for components of the metabolic syndrome (eg, hypertension, elevated LDL-C levels, prothrombotic state) is important in improving clinical outcomes, as is pharmacotherapy for glycemic control in patients with diabetes. Therapeutic lifestyle changes recommended for treatment of metabolic syndrome include smoking cessation, exercise programs, nutritional counseling, and weight control. Patient questionnaires are an effective way to help tailor recommendations to individual patients and thereby increase compliance. Clinicians can also help motivate patients by offering practical tips for modifying diet and eating habits and explaining all the benefits of exercise. These combined approaches can be used to help more patients achieve their lipid goals, and new pharmacologic therapies currently under investigation may further expand available treatment options.