Backgrounds The metabolic syndrome (MS) has been reported as a potential risk factor of coronary artery disease (CAD). The purpose of this study was to determine whether there was a progressive relation between the number of markers of the MS—the MS score—and the degree of atherosclerotic risk profile, and to assess the relation between the MS score and CAD angiographic severity. Methods We retrospectively enrolled 632 patients who underwent coronary angiography for suspected CAD (394 men, 61.0 짹 10.6 years of age). The subjects were divided into 6 groups based on their MS scores. MS was defined by the National Cholesterol Education Program criteria with waist criterion modified into body mass index (BMI) of more than 25 kg/m2. CAD was defined as >50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD angiographic severity was evaluated with a Gensini scoring system. Results Of the 632 patients enrolled, 497 (78.6%) had CAD and 283 (44.8%) was diagnosed as MS. In patients with MS, hypertension was the most frequently observed marker, followed by low HDL, increased BMI, high fasting glucose, and high TG. As the MS score increased, fibrinogen, cystatin C, serum-insulin and the homeostatic model assessment insulin resistance (HOMA) index increased, and the LDL size decreased. Similarly, an increasing MS score was significantly related to the severity of CAD at coronary angiography, as assessed by a Gensini scoring system (Table). Conclusion MS score provides a clinically useful index of MS severity and the associated atherosclerotic risk factor profile. It also correlates with the angiographic severity of CAD.