The risk of coronary artery disease (CAD) in descendants with positive family history of CAD was evaluated in either one of or both the parents among 71 selected families. Subjects were grouped as parents and descendants without and with CAD and descendants spouses without CAD or family history of CAD. All subjects were examined for anthropometric characteristics, fasting blood sugar, serum lipids, lipoprotein sub-fractions, insulin, insulin resistance and pancreatic beta cell function. The results were subjected to statistical analysis by using the analysis of variance (ANOVA). Metabolic syndrome (MetS) was prevalent in the 83% descendants with CAD and 54.6% parents with CAD. The traditional risk factors were observed in both parents and descendants with CAD. Metabolic risk factors, including hypertriglyceridemia, low HDLc levels and hyperglycaemia had a higher frequency in the descendants with CAD. ANOVA showed significant 'F' ratio for the anthropometric characteristics, hypertension, serum lipids, small dense (sd) LDLc levels, HDL2c levels and HDL3c levels in the descendants parents with CAD and CAD + diabetes mellitus (DM), as compared to those without CAD. The descendants without CAD, but with a positive family history had central adiposity, hypertension and had lower HDL levels and elevated sdLDLc levels. Multiple analyses of variance showed that sdLDLc and waist circumference were the most potent risk factors for prevalence of CAD. Thus, we conclude that a positive family history of CAD along with central adiposity and elevation of sdLDLc levels appear to be important factors in the assessment of CAD risk in humans.