The metabolic syndrome a concurrence of disturbed glucose and insulin metabolism, overweight and abdominal fat distribution, dyslipidemia and hypertension, is associated with subsequent development of type 2 diabetes mellitus and cardiovascular disease (CVD). Despite its high prevalence in Asians, no national estimate is currently available on the metabolic syndrome in patients with acute myocardial infarction in Pakistan.A matched case control study using questionnaire and analysis of components of metabolic syndrome was carried out at tertiary care hospitals of Peshawar Pakhtunkhwa.The result showed that patients were 6.19 times more likely to have three or more diagnostic criteria of metabolic syndrome than the controls i.e. 55% vs 17%. This study contributed to the fact that metabolic syndrome is more common in patients with acute myocardial infarction. Screening of adults with central obesity for other parameters of the metabolic syndrome may help to reduce the prevalence of metabolic syndrome as well of myocardial infarction at an early age, which is the complication of metabolic syndrome.