The etiology of one half to two-thirds of deaths among patients with schizophrenia could be attributed to cardiovascular diseases. It is believed that high prevalence of metabolic syndrome mostly contributes to the risk of cardiovascular diseases in schizophrenia. Although the metabolic syndrome is among the leading causes of morbidity and mortality among patients with schizophrenia, fifteen years ago studies investigating the etiology of the metabolic syndrome among patients with schizophrenia were not a part of scientific interest. Recent findings indicate the possibility that increased state of inflammatory response in the organism may underlie the etiopathogenesis of both schizophrenia and metabolic syndrome. For instance, significantly increased levels of proinflammatory cytokines and C reactive protein have been observed in schizophrenia patients with minimal or no exposure to antipsychotics and it has also been revealed that cyclooxygenase-2 inhibitor drugs add-on treatment to the antipsychotic therapy may lead to decrease in clinical symptom severity and alleviate cognitive deficits in the patient group. In this review we aim to provide an update on genetics and environmental factors in the etiopathogenesis of metabolic syndrome in schizophrenia. Numerous mechanisms by which the environmental factors such as unhealthy diet pattern and smoking could contribute to the etiology of the metabolic syndrome in schizophrenia do not differ significantly compared to a healthy population. However, treatment with antipsychotic medications, particularly with atypical antipsychotics, as well as interaction between antipsychotic drugs and environmental and genetic risk factors may additionally lead to heterogeneity of the etiopathogenesis of metabolic syndrome in schizophrenia as well as to complicate treatment approach. Since previous studies have been mostly focused on plausible associations between antipsychotic medications and metabolic abnormalities, we provided a more detailed characteristic of unhealthy diet among schizophrenia patients and its plausible relation to metabolic syndrome. Furthermore, more deeply have been discussed the possible associations between nicotine dependence and metabolic syndrome.