To determine the best lipid discriminant between atherosclerotic and normal coronary vessels in a community based cardiology clinic we measured fasting lipoproteins, apoA1 and apoB in 364 (M 287, F 77; age 65 ± 10) atherosclerotic coronary artery disease proven by angiography or previous myocardial infarction, intervention by PTCA or CABG; TIA, CVA or peripheral arterial disease) and in 123 controls (M 63, F 60; age 60 ± 15) without events and no atherosclerosis on angiography (indicated for valvular heart disease, pacemakers or varia).Cholesterol (6.3 ± 1.1 vs 5.4 ± 1.0), LDL-C (4.3 ± 1.0 vs 3.4 ± 0.9), Triglyceride (TG)(2.1 ± 1.1 vs 1.5 ± 0.8), apoB (1.75 ± 0.36 vs 1.35 ± 0.33) (p < 0.0001) were higher and apoA1 (1.30 ± 0.21 vs 1.45 ± 0.25) and HDL-C (1.09 ± 0.27, 1.33 ± 0.32) were lower in atherosclerotic than in nonatherosclerotic patients. The best discriminant were apoB and TG values. There was a negative relation between TG and HDL-C values. The combination of HDL-C≤0.9 and TG≥1.7 or HDL-C≤0.9 and apoB≥1.7 or TG≥1.7 and apoB≥1.7 mmol/l was found in 217 patients of whom 90% had a previous event. Thus in a standard community based cardiology clinic apoB and TG are relatively better discriminators for atherosclerotic disease than cholesterol, HDL-C or others. This supports the argument that combined and nutrition induced hyperlipidaemia is a strong risk factor for atherosclerosis.