The metabolic syndrome and its components, glucose intolerance, T2DM, hypertension, dyslipidaemia and obesity are increasingly common. Patients with the metabolic syndrome have a higher prevalence of chronic heart failure (CHF) and, once diagnosed, CHF in such subjects is associated with a higher mortality than in those without this co-morbidity. However, early diagnosis of LV systolic dysfunction and symptomatic heart failure may prevent deterioration of heart failure and improve prognosis. The aim of this article is to summarise the prevalence of CHF in people with obesity, hypertension and T2DM, and to review how each co-morbid condition might predispose to and complicate the clinical diagnosis of CHF.