Aim To study the relationship between non-high density lipoprotein cholesterol levels and severity of coronary artery atherosclerosis. Methods This research studied 843 consecutive subjects undergoing coronary angiography who did not receive any lipid-lowering therapy. The severity of coronary artery atherosclerosis was determined using the Gensini score (GS)system. The patients were classified into the four groups according to the quartile of the GS. Then the patients were divided into three groups:the sigle-vessel group, the double-vessel group, the triple-vessel group.Lipid parameters were measured in all groups. The correlation analysis, receiver-operator characteristic and logistic regression analysis were performed, respectively. Results LDLC, non-HDLC and TC/HDLC were all dramatically increased according to the quartiles of GS (P<0.05, respectively), TG/HDLC in upper GS quartile was higher than the 1st and 2nd GS quartile. LDLC, non-HDLC, TC/HDLC in the double-vessel group, the triple-vessel group were significantly higher than those of the sigle-vessel group(P<0.05, respectively), TG/HDLC level had no significant difference. non-HDLC(r=0.315,P<0.01) was more closely related to GS than LDLC(r=0.252,P<0.01), TC/HDLC(r=0.242,P<0.01), TG/HDLC(r=0.123,P<0.01). The area under receiver operating characteristic curve(AUC) of non-HDLC for predicting high GS was 0.729(95%Cl 0.691～0.767,P<0.01) higher than LDLC's 0.694(95%Cl 0.653～0.734,P<0.01), TC/HDLC's 0.681(95%Cl 0.640～0.721,P<0.01), TG/HDLC's 0.564(95%Cl 0.521～0.607,P<0.01). Multivariate logistic regression analysis suggested that non-HDLC(OR=2.2,5%Cl 1.962～3.115) was slightly superior to LDLC(OR=2.5,5%Cl 1.785～2.875), TC/HDLC(OR=1.6,5%Cl 1.483～2.175), TG/HDLC(OR=1.022, 95%Cl 0.927～1.127) in predicting high GS after adjusting for potential confounders. Conclusion non-HDLC levels is a better predictor for the coronary atherosclerosis severity compared with LDLC, TC/HDLC, TG/HDLC.