Summary The genetic linkage of coronary artery disease is well-established. However, the transmission of this disease is not clearly defined. Although the Mendelian autosomal dominant pattern has been seen in familial hypercholesterolemia and mutant MEF2A induced familiar myocardial infarction, and a multifactorial genetic model has been proposed for non-familial CAD, the gender difference in this disease is not well explained. We hypothesized that CAD is a multifactorial inherited disorder with a sex-influenced trait, which shows an autosomal dominant pattern in men and autosomal recessive transmission in women. This hypothesis is supported by the facts including an age-dependent higher prevalence in men, the autosomal locations of CAD associated genes, the gender difference seen even in familiar CAD, and the potential gene–gene interactions between CAD associated genes on autosomal chromosomes and those found on the X chromosome. Further investigation of genetic components will provide not only the critical information about the etiology of CAD, but also help to clarify the confusion in the use of exogenous female hormones in the prevention and/or the treatment of the disease.