Background: Plasma adiponectin is decreased in patients with coronary artery diseases especially in patients with acute coronary syndrome (ACS); however, the correlation between plasma adiponectin and variant angina pectoris (VAP) has not been verified. We compared plasma adiponectin concentrations between VAP and other coronary artery diseases; moreover, we investigated the association between plasma adiponectin concentration and VAP. Methods and Results: Plasma adiponectin concentrations in the VAP group (n=94) were compared with those of the ACS group (n=117), the stable angina pectoris group (n=108), and the normal coronary group (n=76). Plasma adiponectin concentrations in VAP and ACS were significantly lower than that of the normal coronary group (6.6 짹 5.4 vs 5.2 짹 4.0 vs 9.0 짹 6.2 關g/mL, p<0.001, respectively). Multivariate analysis indicated that plasma adiponectin (odd ratio (OR) 0.735, 95% confidence interval (CI) 0.621 to 0.855, p=0.011), smoking (OR 2.012, 95% CI 1.210 to 3.880, p=0.020), and age (OR 0.963, 95% CI 0.938 to 0.989, p=0.006) correlated independently with the development of VAP. Conclusions: Our results suggest that a decrease in plasma adiponectin concentration may be associated with the development of VAP.