Imbalance in mineral metabolism, particularly sodium (Na) and potassium (K), is associated with increased risk of coronary artery disease (CAD). There has been no previous study to elucidate the relationship using hair mineral concentration which is a better reflection of body mineral content compared to conventional tests. A cross sectional observation was conducted on 523 men aged 20 years or older, who had visited the Ajou University Hospital for a periodic health check-up between 2009 and 2012. Hair mineral analysis was performed using mass spectrometry. CAD risk was calculated for each individual using the Framingham risk score. Hair Na and K concentrations showed positive correlations with Framingham risk score. Hair calcium (Ca) and magnesium (Mg) concentrations showed no correlation, while hair Ca/Na and Ca/K ratios showed negative correlations with coronary risk. The highest quartile of hair Na and K had significantly higher odds ratio (3.51 and 2.36) compared with the lowest quartile group and hair Ca/Na had significantly lower odds ratio (0.41) to have higher than 10% of 10 years CAD risk, even after adjustment for major CAD risk factors. High hair Na and K concentration is an independent risk factor for CAD. Hair Na and K concentration may be a useful predictor for CAD risk.