Efficacy of Double vs Standard Empapagliflozin Dose for METabolic syndromE tReatment

Inclusion Criteria: * diagnosis of metabolic syndrome as follows: the presence of obesity (waist circumference ≥ 88 cm in women; ≥102 cm or body mass index (BMI) ≥30 kg/m2) and two of the three following criteria: 1. high blood pressure (systolic blood pressure - in-office measurement: ≥ 130 and/or diastolic blood pressure ≥85 mm Hg or systolic blood pressure - ambulatory measurement: ≥130 and/or diastolic blood pressure ≥ 80 mm Hg) or on anti-hypertensive treatment; 2. impaired glucose metabolism (fasting glucose ≥100 mg/dL or ≥ 140 mg/dL after 120 min in oral glucose tolerance test or HbA1c ≥5.7%) or on glucose-lowering drug treatment; 3. elevated non-high-density lipoprotein (non-HDL ≥130 mg/dL) cholesterol level (atherogenic dyslipidemia) or on lipid-lowering drug treatment Exclusion Criteria: * current treatment with SGLT2 inhibitor * chronic kidney disease with estimated glomerular filtration rate (eGFR) \&lt; 30 mL/min or on dialysis * severely impaired liver function * known hypersensitivity to the active empagliflozin or to any of the excipients contained in Jardiance * history of ketoacidosis * diabetes treated with insulin * pregnancy * decompensated heart failure * acute coronary syndrome * active thromboembolic disease * current treatment for neoplastic disease * active inflammatory disease within 1 month prior to enrollment * expected lifetime \<1 year * non-cooperative patients