BACKGROUND AND OBJECTIVES: Aortic valve sclerosis (AVS) is often considered to be benign and it is also considered to be a manifestation of generalized atherosclerosis that involves the aortic valve. However, it is associated with high cardiovascular morbidity and mortality in a population-based study. This study was performed to evaluate the significance of AVS in patients with suspected coronary artery disease (CAD). SUBJECTS AND METHODS: Patients with AVS (AVS group, n=111) and patients with normal aortic valves (control group, n=99) who underwent coronary angiography (CAG) between May, 2004 and June, 2004 were enrolled in this study. We compared the CAG findings and the CAD risk factors in both groups, and we evaluated the diagnostic value of AVS for predicting CAD. We also performed multivariate logistic regression analysis for the risk factors, including AVS, of CAD. RESULTS: This study showed that AVS is an independent echocardiographic predictor of significant CAD in the patients with suspected CAD (OR=2.55, 95% CI: 1.25 to 5.17, p<0.001). The other independent predictors include the male gender and hypertension. AVS has a relatively high positive predictive value (75.7%) and predictive accuracy (65.2%) for the patients with suspected CAD. CONCLUSION: The recognition of AVS on transthoracic echocardiography should alert the physicians to the possibility of significant underlying CAD and further evaluation is indicated, even though angiographic documentation might not be available.