To investigate risk factors for coronary atherosclerosis in men and women in the recent general Japanese population, we examined coronary arteries obtained from subjects autopsied in the Hisayama cohort study (autopsy rate: 78.7%). The subjects were over 40 years of age and consisted of 125 men and 108 women. They underwent an antemortem medical examination in 1988 and were subject to autopsy at death during an 8-year follow-up period. Atherosclerosis was globally assessed by examining 14 specimens taken from wide areas of epicardial coronary arteries and classified into 6 grades. The frequency of more severe grades of coronary atherosclerosis increased with age in both genders and was greater in men than in women of the same age. Multiple regression analysis revealed that age, systolic blood pressure, serum total cholesterol, and hemoglobin A(1C) were significant risk factors for men. Age, systolic blood pressure, and waist to hip ratio were risk factors for women. Smoking was not significantly correlated with the grade of coronary atherosclerosis in either gender. Thus, aging, hypertension, hypercholesterolemia, obesity, and glucose intolerance are risk factors for coronary atherosclerosis in recent Japanese populations, and the significance of the metabolic risk factors is different between men and women.