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Approximately 20%-30% of the population in industrialized countries suffers from metabolic syndrome (MetS), a condition that may double the risk of diabetes mellitus and heart diseases in the normal population. Both MetS <em>per se</em> and its components increase the risk of atherosclerosis and acute coronary artery disease and heart failure (HF). We reviewed the data from a recent survey of patients admitted to Italian internal medicine wards due to chronic heart failure to ascertain the prevalence and the relationships between MetS and HF in <em>real life</em> patients. Our data shows that some risk factors for this syndrome (above all obesity) reflect a sort of Janus phenomenon in that they are well-recognized risk factors for HF in young people, but they lose their unfavorable predictive value in elderly patients with HF.