Aim To investigate serum levels of homocysteine（Hcy） and nonesterified fatty acid （NEFA）in patients with coronary heart disease （CHD） and relationship between homocysteine, nonesterified fatty acid levels and cardiac severity. Methods A case-control study was conducted in 451 CHD patients diagnosed by clinics. They were divided into three groups: stable angina pectoris（SAP） group（n267）,unstable angina pectoris（UAP） group（n55）and acute myocardial infarction（AMI） group（n129）. All patients and 103 healthy controls were measured the serum Hcy and NEFA concentrations by automatic biochemical analyzer. Furthermore,their changes were analysed based on CHD severity （NYHA Ⅰ-Ⅳ function classification）. The two-sample u-test or t-test was used for statistical test,The P value less than 0.05 was considered statistically significant. Results The serum levels of Hcy were 16.7±10.4，16.8±5.8 and 19.8±11.1 μmol/L in SAP，UAP and AMI groups, which were all significantly higher than healthy controls（13.6±9.2 μmol/L）（P<0.05）,the serum levels of Hcy in AMI group was also significantly higher than both SAP group and UAP group（P<0.05）. The concentrations of NEFA were 513.5±232.6 mEq/L and 774.7±415.3 mEq/L in UAP group and AMI group,which were also significantly higher than healthy controls（353.5±142.1mEq/L）（ P<0.05）,while its serum levels of NEFA in SAP group was 332.7±137.9 mEq/L,which was not significantly higher than that in healthy controls（P>0.05）. Furthermore, statistical test showed that the concentrations of Hcy was increased along with increment of CHD severity （NYHA cardiac functional classification）（P<0.05）,while the levels of NEFA didn’t change compared with it,which occurred only on NYHA Ⅳclassification （P<0.05）. Conclusion There are sulfurated amino acid and fat metabolic disorders in CHD patients. Sulfurated amino acid and fat metabolic disorders may play a certain role in the occurrence and development of CHD