Abstract: AIM To investigate the impact of gender differences on dietary salt intake and coronary atherosclerosis in patients with prehypertension. METHODS A retrospective review was performed on 243 prehypertension patients who underwent coronary angiography without percutaneous coronary intervention with the degree of coronary artery stenosis being 30%-70% from January 2003 to December 2009. Based on gender differences, all patients were sorted into male (n=140) and female groups (n=103). Baseline clinical features were compares as well as laboratory data, information on drugs administered during hospitalization and during the follow up period, related risk factors, and incidence of hypertension and cardiovascular disease (including acute myocardial infarction and/or stroke) in the two groups. Cox regression analysis was utilized to measure the related risk factors of hypertension and cardiovascular disease. RESULTS The female group had a higher average age (61±7 versus 59±7, P<0.01), as well as blood lipids including total cholesterol, low density lipoprotein, high density lipoprotein, and cholesterol were higher than male patients (P<0.01). However, the male patient’s average serum creatinine values and left ventricular diastolic diameter were higher. The rate of somking and drinking history were higher in the male patients compared to female patients. After a median follow-up of 4.53 years (range, 3.1-8.7 years), 71 (50.7%) male patients progressed to hypertension, but the women group had 52 (50.5%) patiens progress to high blood pressure. There were no statistical differences when comparing the two groups (50.7% vs. 50.5%, P>0.05). In terms of cardiovascular disease, 72 patients experienced acute myocardial infarction, including 52 male patients and 20 female patients. In the occurrance rate of myocardial infarction, the male group was higher than the female group (37.1% vs. 19.4%, P<0.01). The women group had an incidence of ischemic stroke greater than the men group (11.65% vs. 4.28%, P=0.03). In the subgroup of high dietary salt intake, 35 patients in the men group had acute myocardial infarction, while compared with only 13 patients in the female group. Incidence of acute myocardial infarction was higher in the male group compared with females (50.7% vs. 25.5%, P<0.01). To further explore risk factors of hypertension and cardiovascular disease, Cox multiple factors regression analysis revealed that a diet of high salt intake was an independent risk factor for hypertension and cardiovascular disease, especially in male prehypertension (P<0.05). CONCLUSION In prehypertension patients, a diet of high salt intake increases incidence of hypertension and cardiovasculr disease. The occurrance rate of myocardial infarction was higher in the male group compared to females; however, the incidence of ischemic stroke was higher in the women group.