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Aim: To compare the effects of different low-density lipoprotein (LDL) cholesterol-lowering statin treatments on small dense LDL (sd-LDL) in hypercholesterolemic patients with metabolic syndrome (MetS). Methods: Forty hypercholesterolemic MetS patients ≥ 30 years of age were randomized to rosuvastatin (n 17) or other statins (n 23) groups. In the other statins group, those taking atorvastatin (n 12) were also evaluated separately. Statin doses were 10 mg/day rosuvastatin, 20 mg/day atorvastatin, 40 mg/day simvastatin, and 40 mg/day pravastatin. Treatment duration was planned to be 8 weeks. Sd-LDL levels were assessed at baseline and at the completion of treatment. Results: After treatment, sd-LDL levels were significantly reduced in all 3 groups (from 29.6 24.8 mg/dL to 8.9 8.5 mg/dL in the rosuvastatin group, p 0.001; from 26.2 15 mg/dL to 14.8 9.6 mg/dL in the atorvastatin group, p 0.02; and from 29.1 16.5 mg/dL to 14.7 11.2 mg/dL in the other statins group, p 0.0001). There was no significant difference in the mean percent changes among groups. Conclusion: Significant reduction in sd-LDL levels was observed after 8 weeks of statin treatment in hypercholesterolemic patients with MetS. This effect was similar for all statins and can be considered a class effect. J Atheroscler