Background Metabolic syndrome is a combination of medical disorders that increase one's risk for cardiovascular disease and diabetes.Whereas the syndrome is under scrutiny and extensive investigations worldwide, it has been very little investigated in Iraq with a considerable lack of local pertinent data. Objectives Estimation of the prevalence of metabolic syndrome in patients with ischemic heart disease and assessing the severity of coronary artery disease in patients who meet the criteria of metabolic syndrome. Patients and methods The study was carried out at Ibn Albitar hospital, a tertiary center for cardiovascular surgery/Baghdad/Iraq from 1st Oct. 2005 to 30th Dec. 2006. A cross sectional design and consecutive sampling procedure were adopted to enroll 300 patients comprising 226 males and 74 females who met the eligibility criteria and were assigned to undergo coronary angiography. Documentation of data regarding medical history, the required measurements, and investigations was accomplished in accordance with a specially designed data sheet that included all relevant information. Results The overall prevalence of metabolic syndrome in the study sample was 69.33 %. Differentially, the prevalence was very much higher among patients with ischemic heart disease 84% than those without ischemic heart disease 10%. The estimated difference was statistically highly significant (p=0.01). Only 240 patients showed angiocardiographic evidence of ischemic heart disease; (single vessel disease 24.2%, two vessels disease 35.8%, triple vessels disease 23.3%, and left main stem disease 16.7%). There was no significant difference in the prevalence of metabolic syndrome among different subgroups of patients with ischemic heart disease classified by the results of coronary angiography. There is a need for having a unified definition of the metabolic syndrome to allow for proper assessment and valid comparison between prevalence data in different populations. Recommendations highlighted the need for wider analytical studies enrolling bigger samples with the aim of obtaining a more valid inference, in addition to community based surveys to help early recognition of metabolic syndrome, identify patients at risk of ischemic heart disease, and reduce the impact of ischemic heart disease on the community.