Background: Several studies have shown that elevated serum homocysteine levels are associated with an increased risk of coronary heart disease (CHD). This survey was designed to investigate the association between hyperhomocysteinemia and CHD in an Iranian urban population. Methods: In a cross-sectional study, 358 residents (129 men and 229 women) of the 17(superscript th) District of Tehran, Iran aged 25-64 years old (mean 44.08±11.77 years) were assessed for ischemic heart disease (IHD) according to the Rose questionnaire and resting electrocardiographic (ECG) analysis by Minnesota code, and CHD risk factors (inc1uding serum homocysteine) were compared between ischemic and non-ischemic groups. Results: Crude prevalence of hyperhomocysteinemia in this population was 53.4%. Mean plasma total homocysteine (tHcy) in men was significantly higher than in women (P=0.001). There was no significant difference in mean serum vitamin B12, homocysteine and folate between the ischemic and non-ischemic groups (P=0.31, 0.16 and 0.51, respectively). Conclusion: According to the results, high serum level of tHcy by itself is not a CHD risk factor in a healthy population, but it should be considered for reduction in CHD patients.