The metabolic syndrome, a combination of disorders that collectively increases the risk of diabetes and cardiovascular disease, is an increasingly problematic effect of several second-generation antipsychotics. The prevalence of its various features in clozapine-treated patients has not been previously established. Of 93 patients receiving clozapine for schizophrenia or schizoaffective disorder, 54% had the metabolic syndrome, compared to 21% of a matched sample of the U.S. population. Lamberti et al. (p. 1273) based these findings on measurements of waist circumference, triglycerides, HDL cholesterol, blood pressure, and glucose; the metabolic syndrome is defined as high values for three or more of these. An editorial on the clinical presentation of metabolic syndrome by Dr. Gary Remington appears on p. 1132.