The purpose of the study was to explore the association between plasma platelet activating factor (PAF) and platelet activating factor acetylhydrolase (PAF-AH) levels and risk of coronary heart disease (CHD) or blood stasis syndrome (BSS) of CHD. Questionnaire, routine clinical assays and plasma levels of PAF, PAF-AH and inflammatory factors hs-CRP and IL-6 were investigated or measured for 120 controls and 150 CHD patients (66 non-BSS and 84 BSS). Plasma PAF levels were higher in CHD patients [49.7 (34.8-73.2 pg/mL)] than in controls [23.8 (14.9-42.3 pg/mL)] (P < 0.001), and in BSS [56.0 (40.1-86.1 pg/mL)] than in non-BSS [47.4 (29.0-67.4 pg/mL)] (P = 0.027). Similarly, plasma PAF-AH levels were higher in CHD patients [11.5 (7.5-15.6 μmol/L)] than in controls [8.1 (5.4-12.6 μmol/L)] (P < 0.001), and in BSS [13.4 (8.7-18.5 μmol/L)] than in non-BSS [9.5 (7.3-14.3 μmol/L)] (P = 0.014). After adjustment for the confounded effects of inflammatory factors or conventional risk factors, plasma PAF and PAF-AH levels still had a significant difference between CHD patients and controls, but plasma PAF-AH rather than PAF levels had a significant difference between BSS and non-BSS. Elevated plasma PAF level contributed to the risk of CHD rather than BSS, and elevated plasma PAF-AH level was an independent risk factor of CHD and BSS.