Emerging evidences have shown that the Glu504Lys variant in ALDH2 gene may greatly reduce the ability of ALDH2 to metabolize acetaldehyde, which could increase the risk of coronary artery disease (CAD) and myocardial infarction (MI). However, the reported results are still conflicting. To investigate the association between ALDH2 Glu504Lys polymorphism and the risk of CAD and MI in Asians, we analyzed all available studies in a meta-analysis.A literature search of PubMed, Embase, Web of Science and Chinese BioMedical (CBM) databases was conducted for articles published before March 1, 2013. The principal outcome measure was the crude odds ratios (ORs) with their corresponding confidence intervals (95% CIs) for evaluating the strength of the association.Meta-analysis showed that carriers of ALDH2 504lys allele were associated with increased risks of both CAD and MI (CAD: OR = 1.28, 95% CI: 1.10-1.48, p = 0.001; MI: OR = 1.58, 95% CI: 1.15-2.19, p = 0.005). Subgroup analysis by country showed significant correlations between mutant genotypes (Glu/Lys + Lys/Lys) and increased risk to MI among Chinese and Korean populations (Chinese: OR = 1.89, 95% CI: 1.16-3.09, p = 0.011; Korean: OR = 1.69, 95%CI: 1.12-2.55, p = 0.013), whereas similar associations were not observed among Japanese populations.The current meta-analysis provides strong evidence that ALDH2 Glu504Lys polymorphism may be associated with increased risk of CAD and MI in East Asians, especially among Chinese and Korean populations. However, more detailed and well-designed studies are still warranted to confirm these findings.