Background: Many studies have demonstrated that metabolic syndrome (MS) is associated with increased risk for cardiovascular diseases and related mortalities, but it is not well known whether the meaningful differences in plaque area of coronary arteries are present between MS populations and non-MS populations. Methods: From September 2007 to June 2010, a total of 239 patients with stable angina pectoris who underwent coronary angiogram and intravascular ultrasound (IVUS) were categorized into two groups: MS group (n=100, 56 men, 64.7짹9.5 years) and Non-MS group (n=139, 98 men, 60.2짹8.4 years). NCEP-ATP III guideline was used to determine the presence of MS and diverse variables containing virtual histology-IVUS (VH-IVUS) finding were compared between two groups. Results: MS group were older age and more likely to be women than non-MS group (p=0.021, p<0.001, respectively). Apolipoprotein A1 (120.1짹19.7 mg/dL vs. 128.3짹20.3 mg/dL, p=0.002) was lower, but homocysteine (10.7짹6.1 umol/L vs. 8.9짹2.7 umol/L, p=0.002) and apolipoprotein B/A1 ratio (0.79짹0.26 vs. 0.73짹0.20, p=0.044) were higher in MS group than non-MS group. In addition, MS group showed more frequent multivessel involvement (p=0.026) and had more distal target vessel in coronary artery (p=0.018) than non-MS group. VH-IVUS finding revealed more abundant plaque volume (224.6짹131.2 mm2 vs. 170.8짹103.2 mm2, p=0.032) and absolute dense calcium volume (16.3짹11.1 mm2 vs. 11.7짹8.5 mm2, p=0.028) in MS-group than non-MS group, but other parameters were not significantly different between two groups. Conclusions: Although MS did not affect the IVUS finding of plaque area in stable angina pectoris patients, it was meaningfully associated with multivessel involvement. These results suggest that MS may affect the course of stable angina pectoris patients. Keywords: Metabolic syndrome, Stable angina pectoris, Intravascular ultrasound