Abstract: AIM To investigate the relationship of the serum bilirubin level and related risk factors of coronary atherosclerosis in patients with coronary heart disease (CHD) using atorvastatin for the first time. METHODS According to inclusion and exclusion criteria, 276 patients who were first diagnosed with CHD were screened and randomly divided into 20 mg/day (158) and 40 mg/day (118) treatment groups. Changes of the above indexes were observed and its correlation was analyzed after 1 month treatment with atorvastatin calcium. Serum bilirubin, C-reactive protein (CRP), serum uric acid (SUA) level and baseline data were detected. RESULTS Whether using 20 mg/day or 40 mg/day of atorvastatin calcium, serum total bilirubin and direct bilirubin levels were significantly increased (P<0.05) compared with those before treatment, whereas indirect bilirubin levels had no significant difference. CRP and SUA levels were significantly decreased (P<0.05). Compared with the two groups, serum total bilirubin and direct bilirubin levels in the 40 mg/day group were significantly higher than in the 20 mg/day group (P<0.05), but indirect bilirubin levels had no significant difference between groups. CRP and SUA levels in the 40 mg/day group were significantly decreased than in the 20 mg/day group (P<0.05). The rate of change of direct bilirubin was significantly correlated with the level of CRP and SUA. Comared with the two groups, before using atorvastatin, serum total bilirubin in the 40 mg/day group was (10.3±2.0) μmol/L. After treatment it was (13.7±2.2) μmol/L. Direct bilirubin levels before treatment were (3.0±1.1)μmol/L and after treatment were (4.6±1.3)μmol/L. CONCLUSION Atorvastatin calcium in the treatment of CHD can increase the level of serum bilirubin and significantly reduce the levels of CRP and SUA. The higher dose had a more significant effect. The increase of serum bilirubin level was correlated with the decrease of CRP and SUA.