PurposeDue to the increase in the prevalence of other risk factors of heart diseases, the age of heart disease has decreased and it has led to premature heart disease. One of the main risk factors of this disease is metabolic syndrome (MetS). One of the key ways to control MetS is dietary modification. The purpose of this study is to investigate the relationship between dietary patterns and MetS in patients with premature heart disease.Design/methodology/approachThis study was conducted on 409 people with premature heart disease. The diagnosis of MetS was made based on the ATP III criteria. Dietary intake for the past year was collected using the validated semi-quantitative food frequency questionnaire. Dietary patterns were determined by factor analysis with principal components approach.FindingsThree dietary patterns were identified, including the healthy, western and traditional patterns. The findings showed that people who followed the traditional pattern more than those who followed less had a lower risk of MetS. (OR:0.23; 95% CI: 0.11–0.52). But, no relation was observed between healthy (OR:1.45; 95% CI:0.64–3.25) and western (OR:1.04; 95% CI:0.51–2.13) patterns with MetS.Originality/valueThe findings of this study showed that following a traditional dietary pattern based on high consumption of whole grains, red meat, viscera, fish, eggs, high-fat dairy products, soft drinks, mayonnaise and solid oil was associated with a lower risk of MetS.