Objective: In the present study, we attempted to analyze the coronary artery lesion characteristics in patients with and without family history (age less than 55 years in male and less than 66 years in female)Methods: We prospectively studied clinical risk factors and angiographic characteristics in 50 patients who have positive family history of CAD and Control group (n =50) had no family history of coronary artery disease underwent coronary angiography which were carried out at cardiology department in the faculty of medicine Cairo University. Angiographic features for both groups were collected and both groups were compared for coronary risk factors. Results: There is highly significance difference between group A and group B in LMA (24% vs. 6%, respectively; P=0.000*), proximal (74% vs. 36%, respectively; P=0.0002*), middle (76% vs. 50%, respectively; P=0.0083*), distal segments (28% vs 12%,respectively; P=0.0093*) and normal coronaries ( 2% vs 16%, respectively; p=0,0162*). No significant difference was found in single ( 38% vs 30%, respectively; p=0,095), double (32% vs 32%, respectively; p=1,00) or triple vessels (24% vs 20%, respectively; p=0,063). No significant difference in localization of lesion in LAD ( 80% vs 72%,respectively; p=0,646), LCX ( 42% VS 36%, respectively; p=0,631) and RCA (54% vs 48 %, respectively; p= 0,764) in group A and group B. There are significance difference between subgroup 1 (LM and/or proximal segment) and subgroup 2 (mid and/or distal segment) for both groups ( p-value 0.0104* in subgroup 1 and p-value 0.0168* in subgroup 2).Male sex, cigarette smoking and dyslipidemia were more prevalent in both groups. It showed that neither statistical significance difference of coronary risk factors found between the groups nor the subgroups in terms of hypertension, diabetes mellitus, dyslipidemia, smoking, obesity.Conclusion: Coronary atherosclerosis was characterized by higher presence LM and proximal lesions in patients with positive family history and middle lesions in patients without family history. And no significant difference was observed in risk factors of CAD in patients with and without family history of CAD.