Objective To discuss the correlation among the level of serum uric acid (UA), metabolic syndrome (MetS) and different compositions of MetS in elderly patients with coronary heart disease (CHD), and provide a basis for preventing and treating MetS. Methods This study was a cross-sectional study. The elderly patients with CHD (n=321) were chosen from Department of Geriatrics in People’s Hospital of Henan Province from May 28, 2020 to Apr. 1, 2021. All patients were divided, according to whether CHD complicated by MetS or not, into MetS group (n=141) and non-MetS group (n=180). The relationship among level of serum UA, MetS and different compositions of MetS was analyzed, and cut-off point of serum UA was analyzed by using ROC curve. Results The level of serum UA increased significantly in MetS group [(383.30±90.42) mg/dl vs. (294.34±85.15) mg/dl, P<0.001], and UA was a risk factor of MetS occurrence (OR=2.141, 95%CI: 1.185~3.867, P=0.012). With the increase of quartiles UA level, the levels of body mass index (BMI), fasting plasma glucose (FPG) and triglyceride (TG) increased gradually, and level of highdensity lipoprotein-cholesterol (HDL-C) decreased gradually (P<0.05). The results of correlation analysis showed that there was significant correlation between level of serum UA and different compositions of MetS (BMI: r=0.326, P<0.001, FPG: r=0.198, P<0.001, systolic blood pressure: r=0.115, P=0.039, diastolic blood pressure: r=0.112, P=0.045, TG: r=0.288, P<0.001, HDL-C: r=-0.230, P<0.001). The results of ROC curve analysis showed that AUC of UA was 0.747 (95%CI: 0.695~0.800, P<0.001) and cutoff value was 332 μmol/L in predicting MetS. Conclusion There is correlation among level of serum UA, MetS and different compositions of MetS in elderly CHD patients. It is suggested that level of serum UA should be strictly controlled in elderly CHD patients.