Vistafin is insulin-mimicking adipocytokine secreted from visceral adipose tissue, which plays an essential role in a number of biological processes affected glucose uptake regulation, inflammation, immunity, insulin resistance, vascular calcification, capillary tube formation, endothelial cell function and angiogenesis. Circulating level of visfatin exhibits to be a sufficiently increased in MetS and Type 2 Diabetes Mellitus (T2DM) patients compared with healthy individuals. Several clinical studies have sshown that serum vitafin may predict Cardiovascular (CV) disease and CV events in MetS and T2DM patients. The review summarizes the various aspects of the role of vistafin as biomarker of MetS compared with commonly used biomarkers, i.e. adiponectin, leptin, resistin, apelin. In future more investigations are needed to better understand the role of vistafin in dysmetabolic-related disease and its ability to predict CV complications in these patient populations.