This study was aimed at probing the effects of intensive cholesterol-lowering therapy with simvastatin on the large artery elasticity of acute myocardial infarction patients. A total of 72 cases of acute myocardial infarction patients were divided into a normocholesterol group (n = 37) and a hypercholesterol group (n = 35) according to their serum low-density lipoprotein. All patients were given oral simvastatin 40 mg/day for 6 months, and their pulse-wave velocity (PWV) of different artery segments and ankle-brachial index (ABI) were measured before and after the therapy. The low-density lipoprotein cholesterol level in both groups decreased significantly (2.13 +/- 0.32 vs 1.56 +/- 0.28, 3.43 +/- 0.80 vs 2.28 +/- 0.47 mmol/l, P < 0.01). The PWV of each artery segment in both the normocholesterol group and the hypercholesterol group decreased significantly (P < 0.05). Pulse-wave velocity in the hypercholesterol group was lowered much more than that of the normocholesterol group (P < 0.05). There were no differences among each artery segment in each group. Ankle-brachial index increased significantly in both groups (1.12 +/- 0.16 to 1.22 +/- 0.12, P < 0.05 in the normocholesterol group, and 1.03 +/- 0.22 to 1.23 +/- 0.16, P < 0.01 in the hypercholesterol group), but ABI increased much more in the hypercholesterol group than in the normocholesterol group (0.21 + 0.15 vs 0.11 + 0.09 P = 0.02). Intensive cholesterol-lowering therapy with simvastatin for acute myocardial infarction patients can significantly improve their large artery elasticity and regress their atherosclerosis. Hypercholesterol patients benefit more from this therapy.