The metabolic syndrome is strongly associated with insulin resistance and visceral obesity and consists of a constellation of
factors such as diabetes, hypertension, dyslipidemia and non-alcoholic steatohepatits, which could in concert increase the risk for cardiovascular
diseases (CVD). CVD, including myocardial infarction and stroke, is one of the leading causes of morbidity and mortality in the
developed countries. Atherothrombosis, characterized by atherosclerotic plaque disruption and subsequent thrombus formation, contributes
to the pathogenesis of CVD. Although therapeutic strategy for CVD has been progressed with anti-platelet and anti-thrombotic therapy,
statins, and inhibitors of renin-angiotensin system, current therapeutic options may have therapeutic limitations because a substantial
number of patients still experience CVD. Therefore, to develop novel therapeutic strategies that specifically target CVD is intensely desired.
We and the others, have recently found that pigment epithelium-derived factor (PEDF), one of the serpins with neuronal differentiative
activity, has insulin-sensitizing actions in the liver and adipose tissues, and exerts anti-inflammatory, anti-thrombogenic and vasculoprotective
properties in vivo, thereby playing a protective role against the development and progression of the metabolic syndrome
and CVD. In addition, serum levels of PEDF have been shown to increase in patients with visceral obesity, insulin resistance, diabetes,
chronic kidney disease and CVD, thus being a novel biomarker of various cardiometabolic disorders. This paper discusses not only the
role of PEDF, but also the clinical utility of measuring its levels in patients with various cardiometabolic disorders.