Background Dyslipidaemia may account for increased risk of cardiovascular disease in central obesity. Pharmacotherapy is often indicated in these patients, but the optimal approach remains unclear. We investigated the effects of atorvastatin and fish oil on plasma lipid and lipoprotein levels, including remnant-like particle-cholesterol and apolipoprotein C-III, in dyslipidaemic men with visceral obesity.Methods We carried out a 6-week randomized, placebo-controlled, 2 x 2 factorial intervention study of atorvastatin (40 mg day(-1)) and fish oil (4 g day(-1)) on plasma lipids and lipoproteins; in 52 obese men (age 53 +/- 1 years, BMI 33.7 +/- 0.55 kg m(-2)) with dyslipidaemia and insulin resistance. Treatment effects were analysed by general linear modelling.Results Atorvastatin had significant main effects in decreasing triglycerides (-0.38 +/- 0.02 mmol L-1, P = 0.002), total cholesterol (-1.89 +/- 0.17 mmol L-1, P = 0.001), LDL-cholesterol (-1.78 +/- 0.14 mmol L-1, P = 0.001), remnant-like particle-cholesterol (- 0.08 +/- 0.04 mmol L-1, P = 0.035), apolipoprotein B (-49 +/- 4 mg dL(-1), P = 0.001), apolipoprotein C-III (-12.6 +/- 6.1 mg L-1, P=0.044) and in increasing HDL-cholesterol (+0.10 +/- 0.04 mmol L-1, P=0.007). Fish oil had significant main effects in decreasing triglycerides (-0.38 +/-. 0.11 mmol L-1, P = 0.002) and in increasing HDL-cholesterol (+0.07 +/- 0.04 mmol L-1, P = 0.041). There were no significant changes in weight or insulin resistance during the study.Conclusions Atorvastatin and fish oil have independent and additive effects in correcting dyslipidaemia in viscerally obese men. Improvement in abnormalities in remnant lipoproteins may occur only with use of atorvastatin. Combination treatment with statin and fish oil may, however, offer an optimal therapeutic approach for globally correcting dyslipidaemia in obesity.