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Background Coronary heart disease is the main complication of type 2 diabetes mellitus; its incidence is closely related to microalbuminuria.The aim of this study was to investigate the correlation between the urinary albumin excretion rate and the incidence and severity of coronary heart disease in elderly type 2 diabetes mellitus patients.Methods A total of 612 hospitalized type 2 diabetes mellitus patients aged 60 years or older,who were given coronary angiography for diagnosis of possible coronary heart disease,participated.Their urinary albumin excretion rate was measured,and the severity of coronary artery stenosis was quantified with the Gensini scoring system to analyze the incidence of coronary heart disease and the severity of coronary artery stenosis.The optimal urinary albumin excretion rate predictive value for coronary heart disease incidence in elderly type 2 diabetes mellitus patients was determined.Results The incidence of coronary heart disease,the number of patients with coronary vascular disease and the Gensini scores were significantly different between the microalbuminuria group and the normal albuminuria group (P ＜0.05).The urinary albumin excretion rate was independently correlated with the occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients (odds ratio (OR) =1.058,P ＜0.0001,95％ confidence interval (CI): 1.036-1.080).Urinary albumin excretion rate and the Gensini score were independently correlated in elderly type 2 diabetes mellitus patients (β=0.476,P ＜0.0001).The best predictive value of urinary albumin excretion rate was 10.45 μg/min for elderly type 2 diabetes mellitus patients.The area under the curve was 0.764,with a sensitivity and specificity of 70.0％ and 72.2％,respectively.Conclusions The occurrence of coronary heart disease in elderly type 2 diabetes mellitus patients with microalbuminuria was higher than that in patients with normal albuminuria,and the severity of the disease also increased in patients with microalbuminuria.In elderly type 2 diabetes mellitus patients,urinary albumin excretion rate was positively correlated with the incidence and severity of coronary heart disease and was also an independent factor contributing to coronary heart disease.