Abstract-Human plasma platelet-activating factor acetylhydrolase (PAF-AH) is a phospholipase A 2 that is primarily associated with low density lipoprotein (LDL). PAF-AH activity has also been found in high density lipoprotein (HDL), although it has recently been indicated that there is no PAF-AH protein in HDL. Plasma paraoxonase 1 (PON1) is an HDL-associated esterase, which also exhibits PAF-AH-like activity. The effect of atorvastatin (20 mg per day for 4 months) on PAF-AH and PON1 activities in patients with dyslipidemia of type IIA (nϭ55) or type IIB (nϭ21) was studied. In both patient groups, atorvastatin significantly reduced plasma PAF-AH activity because of the decrease in LDL plasma levels and the preferential decrease in PAF-AH activity on dense LDL subfractions (LDL-4 and LDL-5). Drug therapy did not affect HDL-associated PAF-AH activity or serum PON1 activities toward paraoxon and phenylacetate in either patient group. However, because of the reduction in LDL cholesterol levels, the ratios of HDL-associated PAF-AH and serum PON1 activities to LDL cholesterol levels were significantly increased after drug administration. The reduction of the LDL-associated PAF-AH activity and the elevation in the ratios of HDL-associated PAF-AH and PON1 activities to LDL plasma levels may represent a new dimension in the antiatherogenic effect of atorvastatin. Key Words: hyperlipidemia Ⅲ monocytes/macrophages Ⅲ platelet-activating factor acetylhydrolase Ⅲ paraoxonase Ⅲ atorvastatin P latelet-activating factor (PAF) is a potent lipid mediator involved in inflammatory diseases 1 as well as in atherogenesis. 2 In plasma, PAF is hydrolyzed and inactivated by PAF-acetylhydrolase (PAF-AH, EC 3.1.1.47), a Ca 2ϩ -independent phospholipase A 2 . 3 PAF-AH has a marked preference for phospholipids with short-chain moieties at the sn-2 position, and with the exception of PAF, PAF-AH can equally hydrolyze oxidized phospholipids containing a polyunsaturated fatty acyl residue at this position. 3 Plasma PAF-AH is complexed to lipoproteins 4,5 ; thus, it is also denoted as lipoprotein-associated phospholipase A 2 . 6 The role of this enzyme in inflammatory and atherosclerotic diseases remains to be established. Indeed, PAF-AH may represent a potent anti-inflammatory and antiatherogenic enzyme because it degrades PAF and proinflammatory oxidized phospholipids, molecules formed during the oxidation of LDL. 7 Consistent with the hypothesis that PAF-AH may exert a cardioprotective role are clinical studies showing that loss of plasma PAF-AH activity due to a G9943 T mutation in the PAF-AH gene may constitute a genetic determinant of atherosclerotic disease in the Japanese population. 8 In contrast to these findings, PAF-AH may exert proinflammatory and proatherogenic actions as a result of the hydrolysis of oxidized phospholipids, because bioactive oxidized free fatty acids 6 and lysophosphatidylcholine are generated. 9,10 A recent clinical study indicating that the mass of plasma PAF-AH could be a potential risk factor for coronary a...