Typical feature of dyslipidemia in patients with metabolic syndrome is increase triglycerides, decrease HDL-cholesterol and presence of small atherogenic LDL particle; nevertheless majority of patients do not reach target level of LDL-cholesterol for their risk category as well. An essential part of treatment should be non-pharmacological approach - lifestyle changes (weight loss, change in eating habits, increased physical activity). In patients in primary prevention without diabetes decision about pharmacotherapy depend on their risk of fatal cardiovascular events in the perspective of 10 years (table SCORE). In diabetic patients and in patients in secondary prevention is pharmacotherapy indicated, unless their LDL-cholesterol does not reach its target values. The primary goal of treatment is LDL-cholesterol, so pharmacotherapy should be started with statins. If the target of LDL-cholesterol is reached and hypertriglyceridemia and/or low HDL-cholesterol persist, it is recommended to add fenofibrate to statin.