We studied lipids, apolipoprotein-E (apo-epsilon) genotypes and other coronary artery disease (CAD) risk factors of 67 CAD patients (male/female ratio 5) in Curaçao. Compared with 57 controls, male CAD patients had higher cholesterol, triglycerides, LDL-cholesterol, apo-B and decreased HDL-cholesterol and HDL-cholesterol/cholesterol concentrations. Other CAD risk factors were: increased fasting glucose and HbA1c concentrations, decreased creatinine clearance, and increased prevalences of lipoprotein (a) concentration > 500 mg/l, renal disease, hyperhomocysteinaemia, diabetes mellitus type II (DM-II), positive CAD family history and cigarette smoking. Male CAD patients had higher plasma alpha-tocopheroleq. Compared with 29 female controls, female CAD patients had higher fasting plasma glucose and HbA1c concentrations, and prevalence of DM-II. Predicting factors for CAD development in the whole CAD group were: DM-II, cigarette smoking, apo-epsilon 3/epsilon 4 and apo-epsilon 4/epsilon 4 Apo-epsilon 4 was associated with lower HDL- and higher LDL-cholesterol concentrations. There is a need for local studies on improvement of diabetic control, reference values of lipoprotein (a) and homocysteine concentrations, on apolipoprotein (a) phenotypes, causes of hyperhomocysteinaemia, and dietary influences on CAD development in subjects who carry the apo-epsilon 4 allele.