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For decades, gout has been associated with several metabolic abnormalities and with ischemic heart disease (IHD).Our aim was to determine the prevalence of metabolic syndrome by Adult Treatment Panel III criteria (ATP III) and ischemic heart disease (IHD) by electrocardiogram (EKG) and/or single photon emission computed tomography (SPECT) in patients with gout.We included 64 consecutive outpatients with primary gout, but no history of IHD, attending our clinic for the first time. Demographic and clinical data were recorded and resting electrocardiogram, lipid profile, fasting insulin, and SPECT with Tc sestamibi were performed. Metabolic syndrome was defined according to ATP III criteria (≥3 of the following data: 1) hyperglycemia (fasting glucose ≥110 mg/dL) or previous diagnosis of diabetes mellitus, 2) hypertension (≥130/85 mm Hg) or previous diagnosis, 3) high-density lipoprotein (HDL) <40 mg/dL (men) or <50 mg/dL (women), 4) triglycerides ≥150 mg/dL, and 5) obesity.IHD was diagnosed in 10 patients (16%); 2 had EKG changes compatible with previous silent myocardial necrosis and the other 8 had abnormal SPECT. The prevalence of metabolic syndrome was 82%, all patients had at least 1 metabolic abnormality, but all the patients with IHD had metabolic syndrome (3 criteria according with ATP III). Patients with IHD differed from those without IHD in the percentage of HDL levels <40 mg/dL (100% vs. 82%; P = 0.05) as well as glucose and insulin levels in the fasting state (129.3 ± 6.1 mg/dL vs. 92.7 ± 16.7 mg/dL; P = 0.000; and 21.1 ± 6.0 vs. 17.5 ± 8.6 UI/mL; P = 0.03) and low-density lipoproteins (143.9 ± 21.3 mg/dL vs. 118.2 ± 47.7 mg/dL; P = 0.014). In contrast, serum creatinine and urea (1.02 ± 0.13 mg/dL vs. 1.5 ± 1.5 mg/dL; P = 0.024; and 33.9 ± 9.3 mg/dL vs. 48.7 ± 46.1 mg/dL; P = 0.039) and creatinine clearance <50 mL/min (10% vs. 37%; P = 0.06) were higher in patients without IHD.In this work, metabolic syndrome was very common among patients with gout. Sixteen percent of the patients, although previously asymptomatic, had IHD, they all had metabolic syndrome. Gouty patients frequently first seek medical care from a rheumatologist. The rheumatologist can have an important role in detecting metabolic syndrome and risk factors for cardiovascular disease.