To investigate the association between plasma homocysteine (Hcy) status and metabolic syndrome (MS) among Saudi patients attending King Abdulaziz Medical City in Riyadh, Saudi Arabia. Methods: A record-based cross-sectional study of 446 patients was carried out. All consecutive plasma Hcy levels from 2015 to 2018 were extracted. International Diabetes Federation criteria for MS were used to classify the patients. A multivariate regression model was Original Article developed to examine the associations between plasma Hcy and MS. Results: The mean plasma Hcy level was 10.52 µmol/L, and 40% of the patients exhibited elevated Hcy status. Male patients had significantly elevated Hcy levels compared to female patients (p<0.001). In addition, plasma Hcy levels were significantly higher in patients diagnosed with diabetes (p=0.021) and hypertension (p<0.001). The prevalence of MS within the study population was 51%. Homocysteine levels were associated with the presence of MS independent of demographic, anthropometric and biochemical variables (odd ratio 1.018; 95% confidence intervals 1.011-1.047). Conclusion: Plasma Hcy levels were elevated in 40% of the MS patients. Homocysteine had weak association with the presence of MS. Additionally, it was associated with some of its components individually. This study has raised the importance of investigating the association between Hcy status and MS among a representative sample of Saudi population. Additionally, examining possible association and interaction between Hcy level and specific component of MS is suggested to be explored in future studies.