Objective To investigate the association of the gene polymorphism of a disintegrin and metalloproteinase with thrombospondin type 1 motifs （ADAMTS） with the vulnerability of carotid atherosclerotic plaque and the lipid-lowering efficacy of atorvastatin in patients with cerebral infarction.Methods Clinical data were collected from 684 patients with cerebral infarction who were admitted to The First Hospital of Hebei Medical University from January 2016 to January 2019， and according to the results of carotid artery sonography， they were divided into stable plaque group with 338 patients and vulnerable plaque group with 346 patients. The two groups were compared in terms of general information， biochemical parameters， and genotype and allele frequencies at rs402007 （G/C） locus. A logistic regression analysis was used to investigate the risk factors for carotid atherosclerotic plaque vulnerability and the interaction between rs402007 gene polymorphisms and risk factors in carotid atherosclerotic plaque vulnerability. The lipid-lowering efficacy of atorvastatin was compared between the patients with different genotypes， and the association between genotype and the efficacy of atorvastatin was analyzed.Results There were significant differences between the two groups in diabetes， low-density lipoprotein cholesterol （LDL-C）， total cholesterol （TC）， homocysteine （HCY）， and fibrinogen （FIB） （P<0.05）. There were also significant differences in GG genotype and GC+CC genotype between the two groups （P<0.05）. Diabetes， LDL-C， HCY， and FIB were risk factors for the vulnerability of carotid atherosclerotic plaque （P<0.05）， and there was interaction between LDL-C and rs402007 gene （P<0.05）. The response rates of the GG， GC， and CC genotype were 82.29% （144 cases）， 84.27% （209 cases）， and 89.27% （233 cases）， respectively. There were significant changes in blood lipid levels in the patients with different genotypes after treatment （P<0.05）. There were significant differences between the two groups in LDL-C before and after treatment and high-density lipoprotein cholesterol， triglyceride， and total cholesterol after treatment （P<0.05）. With GG genotype as a reference， there was no association between GC genotype and efficacy （P>0.05）， and there was an association between CC genotype and efficacy （P<0.05）.Conclusions ADAMTS gene polymorphism is associated with the vulnerability of carotid atherosclerotic plaque and the lipid-lowering efficacy of atorvastatin.