Dyslipidemia is common in patients with acute coronary syndromes (ACS) but the mechanism remains unclear. Apolipoprotein AV (apoAV), a novel member of apolipoprotein family, is involved in lipid metabolism. This study was to investigate plasma apoAV level and its association with lipids and high-sensitivity C-reactive protein (hs-CRP) in ACS patients. ACS patients (n=228) and healthy volunteers (n=232) were included. Plasma apoAV levels were measured by an ELISA method. Compared with controls, ACS patients had higher plasma apoAV, hs-CRP, triglycerides, total cholesterol and LDL cholesterol, as well as lower HDL cholesterol. Interestingly, a positive correlation was observed between apoAV and triglycerides in ACS patients, as compared with a negative correlation in controls. Notably, logistic regression analysis showed that plasma apoAV level was an independent predictor of ACS (OR=0.82, 95% CI 0.70-0.95, p<0.05). Furthermore, both apoAV and triglycerides were positively associated with hs-CRP in ACS patients. However, no significant correlations between apoAV and cholesterol including total cholesterol, HDL cholesterol and LDL cholesterol were observed in ACS patients. Thus, apoAV is an independent predictor of ACS although increased plasma apoAV level is positively correlated with triglycerides in ACS patients. Moreover, plasma cholesterol levels are not influenced by apoAV in ACS patients.