The serum lipid and lipoprotein levels in 15 patients with vasospastic angina were compared with those in 33 patients with no angiographic coronary stenosis and no vasospastic angina after intracoronary acetylcholine infusion. The serum level of apolipoprotein A-I in patients with vasospastic angina (112 +/- 6 mg/dl) was significantly lower (p < 0.05) than that in patients without vasospasm (128 +/- 4 mg/dl). However, there were no differences between the two groups in the serum levels of cholesterol, triglycerides, high-density lipoprotein cholesterol, apolipoprotein A-II, and apolipoprotein B. Thus apolipoprotein A-I may play some role in the prevention of vasospastic angina.