Background: The prevalence of the metabolic syndrome is increasing owing to lifestyle changes leading to obesity. This syndrome is a complex association of several interrelated abnormalities that increase the risk for cardiovascular disease. According to NCEP III guidelines, treatment involves the improvement of the underlying insulin resistance and coexistent risk factors. We assessed whether LDL level could affect the prevalence of coronary atherosclerosis in metabolic syndrome patients. Method: We collected clinical, biochemical, and 64-row multidetector computed tomography angiographic information in 263 consecutive patients. Metabolic syndrome was defined by the NCEP ATP III. We applied WHO Asian Pacific Region criteria for abdominal obesity following as; waist circumference greater than 90 cm in men, 80 cm in women. Results: The study group consisted of 263 64-slice MDCT angiographically documented patients. The metabolic syndrome was diagnosed in 69 (26%) patients. 39 (14%) diabetics, 180 (68%) patients with hypertension. MDCT guided CAD (more than 50% diameter stenosis) patients were increased in higher score among metabolic syndrome 5 factors (p<0.001). Despite higher score of metabolic syndrome factors, however, CAD were lowered by LDL cholesterol level (less than 100 mg/dl) (p <0.05). Conclusion: Level of LDL cholesterol (less than 100mg/dl) showed a reduced prevalence of coronary artery lesions, irrespective of the therapy applied or the changes in high density lipoprotein (HDL) cholesterol or triglyceride levels.