Pyrethroids and the metabolites have been frequently observed in the environment. Animal data suggests that pyrethroids can induce adverse effect on the cardiovascular system but there are no human studies examining pyrethoids exposure as a risk for coronary heart disease (CHD). We analyzed three nonspecific pyrethroids metabolites in urine and studied the association with CHD risk. A total of 72 CHD patients and 136 healthy subjects were recruited in Shanxi province in China from 2013 to 2014 by matching age and gender. The median concentrations of urinary cis-CDDA (cis-3-(2,2-dichlorovinyl)-2,2-dimethyl cyclopropane carboxylic acid), trans-CDDA (trans-3-(2,2-dichlorovinyl)-2,2-dimethyl cyclopropane carboxylic acid) and 3-PBA (3-phenoxybenzoic acid) among healthy subjects were 1.03, 0.42, 0.74 μg/L respectively, while the median concentrations of the three metabolites among CHD patients were 1.93, 1.07, 1.09 μg/L respectively, significantly higher than healthy subjects. Upper tertile of urinary pyrethroid metabolites were associated with an increased risk of CHD compared with the lowest tertile (cis-CDDA: ORT3vsT1 = 6.86, 95% CI: 2.76-17.06, p-trend = 0.000; trans-CDDA: ORT3vsT1 = 6.94; 95% CI: 2.80-17.19; p-trend =0.000; 3-PBA: ORT3vsT1 = 3.62; 95% CI: 1.48-8.88; p-trend = 0.009; total pyrethroid metabolites: ORT3vsT1 = 4.55; 95% CI: 1.80-11.54; p-trend = 0.002). This study provides information on pyrethroids exposure in China and reveals a possible positive association between pyrethroids exposure and the risk of coronary heart disease.