Atherosclerotic cardiovascular disease (ASCVD) continues to be the leading cause of death worldwide. Metabolic syndrome is associated with an increased risk of ASCVD. With the prevalence of metabolic syndrome continuing to increase, it is important to understand the relationship between these risk factors and development of ASCVD. Endothelial dysfunction (ED), an early, essential step in atherosclerotic plaque formation, is the key link. Here we review diagnostic methods of ED and the mechanisms of each metabolic syndrome component contributing to ED. Finally, the effects of current treatments of metabolic syndrome on ED will also be discussed.

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