Introduction : Adipocyte-specific fatty acid-binding protein (A-FABP), abundantly expressed in adipocytes and macrophages, plays a central role in the development of atherosclerosis and diabetes mellitus in experimental animals. Hypothesis : We assessed the hypothesis that A-FABP is also plays a central role in the development of atherosclerotic cardiovascular disease and diabetes mellitus in humans. Methods : In a total of 175 Korean adult, in whom coronary angiogram were performed, anthropometrical and biochemical parameters were measured. Serum A-FABP levels were measured using ELISA. The presence of metabolic syndrome was diagnosed according to American Heart Association/National Heart, Lung and Blood Institute (AHA/NHBL) Results: Among the subjects, 136 subjects (77.2%) had coronary artery disease (CAD) and 61 subjects (34.9%) had diabetes mellitus. Serum A-FABP level in CAD patients is showned significantly higher than in non-CAD patients (46.75 짹 17.79 ng/mL vs. 26.75 짹 9.48 ng/mL, p < 0.001). Serum A-FABP level in diabetes mellitus and metabolic syndrome patients is also showed significantly higher than in non-diabetic and non-metabolic syndrome patients. In addition, serum A-FABP level in CAD patients is showed significantly higher than in non-CAD patients after adjustment for sex, age, diabetes mellitus and metabolic syndrome (p = 0.035). And serum A-FABP level in diabetic patients is also showed significantly higher than in non-diabetic patients after adjustment for sex, age, CAD and metabolic syndrome (p < 0.001). Conclusions: In conclusions, serum A-FABP might be a predictable marker of coronary artery disease and diabetes mellitus in Korean adults.