Metabolic Syndrome (MeS) has reached epidemic proportions among younger individuals. We sought to determine the prevalence of MeS and its influence on the risk of Acute Coronary Syndrome (ACS) in a younger patient population (≤50 years old). Consecutive patients aged < 50 years hospitalized with the first episode of ACS were categorized whether or not they meet the modified NCEP-ATP III criteria for MeS.1 Diabetic patients were excluded. The control group was comprised of subjects with a de novo diagnosis of CAD but without MeS or DM. The prevalence of MeS in the initial sample of 212 patients with ACS was 26% (N=55). Of the 75 subjects included in the final analysis, 55 patients had MeS (C1) and 20 did not (C2). Mean age, sex, LDL, and Framingham risk scores were not significantly different. Patients with MeS were significantly more likely to present with STEMI (OR 12.67, 95% CI 1.98-78.40, P=0.004), and have lower ejection fractions (45±12% vs. 58±3%, p=0.0001). Among patients younger than 50 years presenting with the first episode of ACS, the prevalence of MeS was high even in the absence of traditional cardiovascular risk factors. Increased incidence of STEMI and reduced EFs were more commonly seen among individuals with MeS.