Metabolic syndrome: hyperuricemia. This image focuses on the "H" phenomenon consisting of the four major players in the MS: Hyperinsulinemia, Hypertension, Hyperlipidemia and the Lipotoxicity – Obesity toxicity triad, and Hyperglycemia. These players have frequently been referred to as the "deadly quartet" and the "H" phenomenon. It is important to note the central position of insulin resistance in this image and also hyperuricemia. Hyperuricemia is flanked by hyperhomocysteinemia to indicate its importance in the MS. Each of these players has its own important role and this image helps to portray the clustering effect and synergism to contribute to an overall increased oxidative – redox stress to the endothelium of the vasculature.