This study is the first report on the prevalence of coronary heart disease (CHD) and its associated risk factors in adult residents of Tehran. Standard supine ECG data were collected for 5984 men and women aged ≥ 30 years and coded by Minnesota criteria. All major cardiovascular risk factors were also measured. Based on Rose angina, self-reported history of CHD or ECG-defined CHD, the aged-adjusted prevalence of CHD was 21.8% (22.3% in women and 18.8% in men). Variables independently associated with CHD were female sex, age, systolic blood pressure, 2-hour postprandial glucose, body mass index, waist-to-hip ratio and LDL/HDL cholesterol ratio.