Metabolic syndrome (MS) is widespread which explains high relevance of the topic. The MS development depends on various factors (age, race, social and economic status, level of physical activity, cultural development, diet, genetic background and educational level). Traditionally, the MS assessment and cardiovascular risk stratification includes measurement of total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, as well as glucose and insulin levels. Some other factors are being investigated and might serve as the surrogate endpoints for the effectiveness of treatment and prevention strategies in addition to insulin resistance indices (HOMA-IR, Caro). These include some systemic biomarkers such as highly sensitive C-reactive protein, leptin and adiponectin, which mediate the link between inflammation and obesity, as well as potentially prognostic markers of cardiovascular diseases. The paper considers the gender specificity of the MS and main components of the MS, such as hypertension, insulin resistance, obesity, and dyslipidemia. We review different approaches of international guidelines and specific regional and national characteristics and analyze gender-related peculiarities of each component of the MS in order to justify an individualized choice of management approach. © 2020 All-Russian Public Organization Antihypertensive League. All rights reserved.