**5. Screening for MetSy in the general public**

Screening can include individuals with pre-symptomatic or unrecognized symptomatic disease [21]. Several studies have shown the importance of screening [22–24].

Health-screening programmes have been effectively used to pinpoint publichealth challenges [25–40], and many countries have implemented nationwide health screening and intervention programmes that specifically target MetSy [41]. The first Framingham Risk Score is a gender-specific score that identifies patients at risk of developing cardiovascular complications within a 10-year period. It factors in age, sex, LDL cholesterol, HDL cholesterol, smoking, blood pressure and also whether the patient is on treatment or not for hypertension, lipidaemia and diabetes, and smoking [42]. Artigao-Rodenas et al. [42] applied the Framingham Risk Score in a prospective cohort study of four years in Spain and found that the model had a good predictive value, with negative predictive values in both sexes, a specificity of 85.6% in women and sensitivity of 79.1% in men in a population with high risk of cardiovascular disease. The model had a significant cumulative probability of individual survival by tertiles in both sexes with a p value <0.001.
