Objective: To estimate the prevalence of metabolic syndrome (MetS) and its separate components in the adult population of the district of Tetovo. Methods: Total of 630 subjects aged over 18 years were selected at random, from the primary healthcare register, to constitute a representative sample of a population in the district of Tetovo, adjusted for age and sex. MetS is defined according to the definition of the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATPIII). Results: The prevalence of MetS in the district of Tetovo was 28.25%. It was significantly higher in women than in men (34.06% versus 22.26%, p=0.004). The largest number of people with MetS living in rural areas (31.32% versus 23.60%, p=0.002). Of the particular components of MetS, 52.06% of the population had increased arterial blood pressure, 46.35% reduced values of high-density lipoprotein cholesterol (HDL-C) and 43.17% abdominal adiposity (AA). In women population, more dominated was abdominal adiposity (59.38% and 26.54%, p=0.000), in men more dominated was increased arterial blood pressure (53.44% and 50.65%, p=0.48). Conclusion: The prevalence of MetS in our population is high, particularly in women. The prevalence rates for arterial hypertension and abdominal obesity are among the highest reported for the region. Advice on diet and change in lifestyles, in addition to the pharmacological treatment of this category, would contribute to the prevention of cardiovascular disease, type II diabetes and complications from these diseases.