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Introduction: Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specially in Iran. An accurate assessment of the incidence of coronary heart disease (CHD) is very important for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years follow-up. Methods: The population of MASHAD cohort study were followed up for 6 years, every 3 years initially by phone and those who reported symptoms of cardiovascular disease (CVD) were asked to attend for a cardiac examination. An estimate of the incidence of CHD was determined with 95% confidence interval (95% CI) and multiple logistic regression analysis was performed to assess the association of several baseline characteristics with the incidence of a CHD event. Evaluation of goodness-of-fit was undertaken using ROC analysis. CHD cases were divided into four different categories: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results: In the six years of follow-up of the Mashhad study participants, the incidence density of CHD events in men and women in 1000 person-year with 95% confidence intervals were 19.20 (8.10-30.30) and 11.60 (7.30-15.90), respectively. The areas under ROC curve (AUC), based on multiple logistic regression model of CHD outcome, was determined to be 0.783. Conclusion: Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age, and our final model was able to predict approximately 78% of CHD events in this Iranian population.