Our study aimed at investigating the relationship between metabolic syndrome (MS) and coronary heart disease (CHD) in aged patients, including 125 patients (age> or =60 years). Of them 78 cases belonged to the CHD group, which were subdivided into the CHD-MS group (38 cases) and the simple CHD group (40 cases); the other 47 patients without CHD belonged to the non-CHD group, which were subdivided again into the MS group (11 cases) and the control group (36 cases). Body mass index (BMI), blood lipids, blood uric acid, plasma fibrinogen, blood glucose and blood pressure of every patient were detected. The anatomy of coronary vessels was analyzed by selective coronary angiography to evaluate the relationship between MS and CHD. We found that the prevalence of MS in CHD group was significantly higher as compared to the groups not suffering from CHD (p<0.01). The CHD-MS group showed a higher prevalence of multivessel disease (p<0.05), unstable lesions (p<0.05) and needed more revascularization procedures (p<0.05) than the simple CHD group. The prevalence of CHD and the number of blocked coronary vessels were directly correlated with MS by Spearman correlation analysis (r=0.225, p<0.05; r=0.361, p<0.01). Logistic regression analysis demonstrated that both the risk of having future CHD and the number of blocked coronary vessels were directly correlated with MS (p<0.01; p<0.01), suggesting that MS can predict the prevalence and extent of future CHD in the elderly.