Background: previous studies have demonstrated that coronary artery calcium score (CACS) assessment combined with risk factors among asymptomatic adults provides prognostic information superior to either method alone, and the combined approach can more accurately guide primary preventive strategies for patients with coronary artery disease (CAD) risk factors. Objective: the purpose of this study was to assess the presence and extent of coronary calcium in symptomatic type 2 diabetic patients with metabolic syndrome by MSCT. Patients and Methods: this was a prospective observational study that was done between January 2018 and December 2018. The study included 150 patients referred to the MSCT Coronary Angiography unite in Mustafa Kamel Military hospital (Alexandria, Egypt) with metabolic syndrome according to IDF. Results: in our study 51 cases (86.4%) of those with serum parathyroid hormone level less than 65 pg/dl had a coronary calcium score (CCS) less than 10 compared to 8 cases (18. 6%) among those with more than 65 pg/dl (p value 0.001), while 0% out of those with normal serum parathyroid hormone less than 65 pg/dl had a CCS more than 200 (p value= 0.001) while 100% cases with CCS more than 200 had serum parathyroid level more than 65 pg/dl. So, the trend toward a high CCS is linked to increasing serum parathyroid hormone level. Conclusion: CAC screening is accurate and valuable modality as a completely non-invasive and relatively timeefficient screening way when avoiding high radiation burden to patients with metabolic syndrome criteria even when asymptomatic.