Several randomized clinical trials have suggested that atorvastatin and pravastatin may differ in terms of their pleiotropic effects. To verify this, we compared the effects of both statins on glucose tolerance, adipokine concentrations and inflammatory markers. A total of 36 hypercholesterolaemic patients without known coronary heart disease (CHD) were enrolled in an open-label, randomized, crossover study. The patients received pravastatin or atorvastatin (10 mg/day) for 4 months and then switched to the other statin for an additional 4 months. At the end of both treatment periods, atorvastatin significantly reduced the concentration of serum lipids (total and low-density lipoprotein-cholesterol and triglycerides) and inflammatory markers (high-sensitivity C-reactive protein and tumour necrosis factor-a) and increased serum adiponectin levels compared with pravastatin treatment. Although these effects would be expected to improve insulin sensitivity, atorvastatin did not affect glucose tolerance, which was assessed by fasting glucose and insulin concentrations, the homeostasis model assessment index and glycosylated haemoglobin (HbA(1c)) levels. Only obese patients showed increased HbA(1c) levels after atorvastatin treatment. Our results suggest that atorvastatin has both advantages and disadvantages compared with pravastatin treatment. Further studies are required to compare the relative clinical value of atorvastatin and pravastatin, especially in obese patients without CHD.