The incidence and prevalence of metabolic syndrome has been increasing globally with no signs of abating. Individuals with metabolic syndrome are at increased risk of multiple comorbidities, including cardiovascular disease and type 2 diabetes mellitus. Studies show that there is a paradoxical relationship in African Americans however, as they experience a higher rate of cardiovascular disease and type 2 diabetes mellitus despite having a lower prevalence of metabolic syndrome when compared to whites. The triglyceride paradox, an unusual phenomenon in which African Americans consistently express a more normal triglyceride status even when having conditions known to be characterized by high triglyceride levels, is believed to account for this paradoxical relationship. In this manuscript, we review the history and pathophysiology of metabolic syndrome while also discussing the importance of the triglyceride paradox in explaining the inverse relationship that exists between metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus in African Americans. In addition, we advocate for decreasing the triglyceride cutoff value when diagnosing metabolic syndrome in this population to more precisely determine who is at risk for developing type 2 diabetes mellitus and cardiovascular disease.

Metabolic Syndrome

African Americans

Type 2 Diabetes Mellitus

Cardiovascular Disease

Triglyceride Paradox

cardiovascular disease

type 2 diabetes mellitus

World Health Organization

European Group for the Study of Insulin Resistance

American Heart Association

National Heart, Lung, and Blood Institute

National Cholesterol Education Program

American Association of Clinical Endocrinologists

Internal Federation of Diabetes

high density lipoprotein cholesterol

triglyceride-rich lipoprotein particle

© 2025 The Author(s). Published by Elsevier Inc.