NPPB and metabolic syndrome: Step 2: Laboratory testing beyond glycemic control should be included—HbA1c plus a full fasting lipid panel (total cholesterol, LDL-C, HDL-C, and triglycerides), renal function markers (serum creatinine and eGFR), and urinary albumin-to-creatinine ratio—to detect early dyslipidemia and nephropathy; NT-proBNP may then be measured to screen for myocardial stress, but its sensitivity in subclinical HF is limited, and levels can be falsely normal in obese patients [23,40,41,42].