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Abstract: Objective: : Coronary artery disease (CAD) is the major cause of death in developing countries, such as Iran. The apolipoprotein E gene (APOE) is considered an important genetic determinant of CAD. In this study, the relationship between APOE polymorphism with lipid variation in CAD patients in Kermanshah, Iran was investigated. Methods: : This case–control study consisted of 115 CAD patients who angiographically had at least 30% stenosis and 135 unrelated controls. APOE polymorphism was detected by PCR-RFLP and serum lipid level was measured enzymatically. Results: : The APOE-ε4 and -ε2 allele frequencies were significantly higher in the CAD patients than in the control group (P < 0.001). The CAD patients with ε3/ε4 genotype had also higher TC (P < 0.001) and LDL-C (P < 0.01) and lower HDL-C (P < 0.03) levels than that of the control group. Conclusions: : APOE-ε4 allele is a risk factor for CAD, so that carriers of this allele with high levels of LDL-C may be susceptible to CAD and myocardial infarction. [Copyright &y& Elsevier]