Aim To investigate the changes of blood lipid and cholesterol metabolism markers (cholesterol synthesis and absorption markers) in high-risk subjects of coronary heart disease before and after atorvastatin treatment, and to analyze the correlation between them. Methods 159 high-risk subjects of coronary heart disease were enrolled, and 20 mg atorvastatin per day was taken for four weeks. Blood lipids and cholesterol synthesis markers squalene/cholesterol (TC), desmosterol/TC, lathosterol/TC) and cholesterol absorption markers (sitosterol/TC, stigmasterol/TC, campesterol/TC) were determined respectively before and after treatment. According to the low density lipoprotein cholesterol (LDLC) level after atorvastatin treatment, the selected subjects were divided into two groups:good response group and poor response group. The changes of blood lipid and cholesterol metabolism markers and their correlation were analyzed in the two groups. Results After atorvastatin treatment, blood lipids were reduced in two groups, in addition to high density lipoprotein cholesterol increasing (9.4% in good response group, 7.4% in poor response group). TC, LDLC decreased significantly in good response group compared with the poor response group (P＜0.01). In good response group, the decrease of TC was positively correlated with the decrease of squalene/TC and sitosterol/TC (r＝0.247, r＝0.205, P＜0.05), and the decrease of LDLC was positively correlated with the decrease of campesterol/TC (r＝0.193, P＜0.05).In poor response group, the decrease of TC was negatively correlated with the decrease of stigmasterol/TC (r＝-0.388, P＜0.01), and the decrease of LDLC was negatively correlated with the decrease of squalene/TC, stigmasterol/TC and sitosterol/TC (r＝-0.280, P＜0.05; r＝-0.517, P＜0.01; r＝-0.320, P＜0.05). Conclusions After atorvastatin treatment, the changes of TC and LDLC in good response group are more obvious than those in poor response group, but the changes of cholesterol metabolism markers are not significant. In good response group, the decrease of TC and LDLC are positively correlated with cholesterol metabolism markers, whereas negative correlation is found in poor response group.