Abstract: AIM To analyze coronary artery disease (CAD) risk factors and the relationship between coronary artery stenosis severity and CAD risk factors in elderly Chinese patients with suspected CAD. METHODS A large cohort of 4 732 consecutive patients (aged ≥60 years) who had been diagnosed with CAD or without CAD by coronary angiography was studied retrospectively. In all, 3 539 consecutive patients with angiographically proven CAD (CAD group) and 1 193 consecutive individuals without CAD (control group) were included in the study. CAD risk factors, coronary artery lesion severity, Gensini cumulative scores and branch numbers of coronary artery stenosis were examined and compared. RESULTS Multiple linear regression analysis demonstrated that Gensini scores were positively correlated with age, male gender, hypertension, hyperlipemia, diabetes mellitus, chronic kideny disease, cerebrovascular disease and fasting blood-glucose but were negatively correlated with total bilirubin levels. Branch numbers of coronary artery stenosis were positively correlated with age, smoking, male gender, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, cerebrovascular disease and fasting blood-glucose and were also negatively correlated with total bilirubin levels. Multivariate binary logistic regression analysis showed that diabetes mellitus (OR=2.591, 95% CI: 1.942-3.458, P<0.01) was the most important independent risk factor for CAD followed by male gender, hypertension, smoking, chronic kidney disease, high low-density lipoprotein cholesterol, and age. However, total bilirubin level was a protective factor for CAD (OR=0.960, 95% CI: 0.941-0.979 (P<0.01). CONCLUSION Diabetes mellitus is the most important independent CAD risk factor in elderly Chinese patients with suspected CAD. However, total bilirubin is an independent protector factor.