Abstract: AIM:To investigate the effects of the R219K polymorphism of ATP-binding cassette transporter A1 (ABCA1) gene on serum lipid levels and the response to statin therapy in patients with acute myocardial infarction (AMI). METHODS: A total of 250 subjects were studied (150 cases with AMI and 100 controls without signs or symptoms of coronary heart disease). AMI patients were treated with pravastatin (40 mg/day). Fasting serum lipids were determined before and after 12 weeks of treatment. Genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The R219K polymorphism of ABCA1 gene was not significantly associated with AMI (P>0.05). Compared with controls, patients with the RR genotypes had significantly higher serum triglyceride (TG) levels and lower high-density lipoprotein cholesterol (HDL-C) levels than those with the KK genotypes (P<0.05). The effects of pravastatin to increase HDL-C levels were significantly better in KK homozygous patients compared with patients with RR-homozygous patients (P<0.05). CONCLUSION: The R219K polymorphism of ABCA1 is associated with altered lipoprotein levels and R219K variant significantly modulates the HDL-C response to pravastatin in patients with AMI.