Aim To explore the effect of apolipoprotein E (Apo E) polymorphism on chronic heart failure. Methods Based on clinical symptom,left ventricular end diastolic diameter index (LVEDDI),left ventricular ejection fraction (LVEF) and fraction shortening (FS),a total of 247 patients sufferring from hypertension and coronary heart disease were divided to two groups:140 patients with normal heart function and 107 patients with chronic systolic heart dysfunction. Polymerase chain reaction-restricted fragments length polymorphism was used to determine the Apo E genotypes for all patients. Results The ε4 allele frequency and the Apo E ε4 carriers were significantly higher in the heart dysfunction patients group than those in the normal heart function group (P><0.05). The Apo E ε4 was an independent risk factor for chronic heart dysfunction in the population of hypertension and coronary heart disease (P><0.01). Conclusion The Apo E ε4 may represent an important genetic risk factor for the development of chronic heart failure in the population of hypertension and coronary heart disease.