Objectives: Little is known about the role of adipokines in the pathogenesis of coronary artery disease in young patients. The aims of this study were to compare serum levels of adipokines and expression of adipokines in peripheral blood leukocytes in patients with premature coronary artery disease (CAD), metabolic syndrome and healthy individuals. Design and methods: Sixty-five patients with premature CAD (men 18-45 years old and women 18-55 years old) formed the study group. The control groups were 75 patients with metabolic syndrome and 50 healthy individuals. For each group, RNA expression in peripheral blood leukocytes was determined for 24 different adipokines and 11 adipokines were examined in serum. Results: In individuals with CAD, serum visfatin levels were significantly higher than in metabolic syndrome and healthy controls (2.3 vs. 1.6 vs. 0.7 mu g/L, P < 0.001) while both omentin-1 (92.9 vs. 587.0 vs. 552.3 mu g/L, P < 0.001) and ZAG2 (45.5 vs. 72.5 vs. 77.1 mg/L, P < 0.001) levels were lower. The receiver operating curve (ROC) analysis for testing the validity of these adipokines in the diagnosis of CAD compared to control groups provided the following areas under the curve (AUC): omentin-1 AUC 0.97 (cut-off <= 222 mu g/L), ZAG2 AUC 0.89 (cut-off <= 51.7 mg/L) and visfatin AUC 0.74 (cut-off >= 1.0 mu g/L) (P < 0.001 in all cases). Visfatin and omentin-1 serum levels did not differ between the acute phase of myocardial infarction and the chronic phase of CAD. In patients with CAD, we found no significant relation between mRNA expression and adipokine concentration. Conclusion: Serum omentin-1, visfatin and ZAG2 could serve as biomarkers of premature CAD in young apparently healthy people.