Aim To measure the serum adipocyte fatty acid binding protein (A-FABP) levels in patients with and without coronary artery disease (CAD),trying to investigate the relationship between A-FABP and severity of coronary stenosis,risk factors of CAD.Methods The study cohort included 340 subjects who underwent coronary angiography.The severity of coronary artery stenosis was assessed by the numbers of involved coronary artery branches and the sum of the Gensini scores.Serum A-FABP levels were determined by enzyme-linked immuneosorbent assays.Results The levels of serum A-FABP were significantly higher in patients with three vessel lesions (18.6(13.8～24.0)μg/L) than those with single vessel lesion (17.5(13.5～20.3) μg/L,P<0.05) and those with non-lesions (16.4(13.5～20.4) μg/L,P<0.05).CAD patients tend to have higher A-FABP levels (18.3(13.2～22.8) μg/L) than non-CAD subjects (16.4(13.5～20.4) μg/L),but the difference did not reach statistical significance (P=0.088).Women had higher serum A-FABP level than men (20.0(16.9～23.9)vs 15.4(12.5～20.3)μg/L,P<0.05) and the difference in A-FABP were statistically significant between CAD patients and controls in females(22.8(18.6～25.7)μg/L vs 18.1(15.6～21.8) μg/L).Serum A-FABP levels were positively correlated with Gensini scores in both men (r=0.105,P<0.05) and women (r=0.405,P<0.01).Multiple linear regression analysis showed that serum A-FABP level was independently associated with Gensini scores in women (P=0.018),but not in man.A-FABP positively associated with triglyceride (TG)(r=0.187,P<0.01),fasting blood-glucose (FBG)(r=0.115,P<0.01) and high sensitivity C-reaction protein (hs-CRP)(r=0.135,P<0.05),and inversely with high density lipoprotein cholesterol (HDLC) (r=-0.168,P<0.01) and apolipoprotein(ApoA1)(r=-0.126,P<0.05).Conclusion Serum A-FABP levels could reflect the extent of coronary artery atherosclerosis,and it is associated with CAD more closely in females than in males.A-FABP might participate in glucose and lipid metabolic disorders.