Objective:To investigate the correlation between the plasma sphingomyelin (SM ) levels and the severity of coro‐nary artery disease in patients with coronary atherosclerotic heart disease(CAD) on admission .Methods:Clinical data of 464 pa‐tients undergoing coronary angiography were retrospectively analyzed ,which included 345 male cases and 119 female cases with mean age of 62 .71 ± 0 .46 .The patients were divided into stenosis group (n=327) and normal group (n=137) according to the results of coronary angiography .The severity of coronary artery stenosis was calculated according to Gensini score .The SM levels of all patients were measured on admission .Results:SM levels in control group and stenosis group were 39 .45 ± 0 .91 mg/dL ,45 .05 ± 0 .78 mg/dL ,respectively ,and the difference between the two groups was statistically significant (P<0 .001) .SM levels were positively correlated with Gensini scores(r=0 .155 ,P=0 .001) .The Gensini scores according to their tertiles of SM levels were 6(0‐38) ,18(2‐50) ,19(0‐49) ,respectively .The differences regarding Gensini scores among the three groups were statistically significant (P=0 .035) .After multiple related risk factors had been corrected ,the multivariate linear regression analysis showed that plasma SM levels were independently associated with Gensini scores (β=0 .143 ,95% CI 0 .148~0 .654 ,P=0 .002) .Conclusions:SM level was significantly associated with coronary angiography Gensini score ,and its level might be an independent risk factor for predicting the degree of coronary stenosis .SM might provide novel therapeutic tar‐get for the treatment of CAD .