 Patients with metabolic syndrome, insulin resistance, and elevated triglycerides of 150 mgdl or higher will be randomized to one of four groups: 1 placebo; 2 metformin; 3 fenofibrate; or 4 combined metformin and fenofibrate for a period of 12 weeks after titration to target dose. We are interested in the effects of these therapies on triglyceride levels, HDL-C, insulin resistance, and markers of inflammation. 