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Objective To investigate the relationship among -75 bp/+83 bp polymorphism in apolipoprotein A1 (apo A1) gene, lipids levels and the occurrence of coronary atherosclerosis disease (CAD).Methods We determined distributions of two MspI polymorphisms of the apo A1 gene at -75 bp and +83 bp, and blood lipids levels among 137 Chinese patients (92 with CAD and 45 in the control group) in relation to circulating lipids and coronary angiography. Results The demographic information for 137 subjects showed that subjects with CAD tended to have more unfavorable lipoprotein variables. Genotype distributions at both sites were different between the CAD and control groups. Furthermore, the control group had higher M1-/M2- frequencies than the CAD group (M1: P<0.005; M2: P<0.05) and the M1-(A) and M2- alleles were associated with increased high-density lipoprotein cholesterol (HDL-C) (M1-: P<0.0001; M2-: P<0.05) and apo A1 (M1-: P<0.0001; M2-: P<0.05) levels. M1- and M2- were significantly negatively correlated with CAD (P<0.01 and P<0.05, respectively).Conclusions Our results suggest that changes from G to A at the -75 bp site and from C to T or G to A at the +83 bp site do increase circulating levels of apo A1 and HDL-C. And those individuals with these changes are likely to have a lower risk of developing CAD.