Objective To investigate the antihyperlipidemic effect of electroacupuncture at Fenglong acupoint on patients with hyperlipidemia and its effect on the expression of ATP-binding cassette transporter A1 (ABCA1) in macrophages co-cultured with human serum. Methods A total of 120 hyperlipidemia patients with sputum stasis syndrome were randomly divided into electroacupuncture group, drug group, and control group, with 40 patients in each group. The patients in the electroacupuncture group were given electroacupuncture at Fenglong, those in the drug group were given oral Xuezhikang, and those in the control group were not given special treatment. The levels of triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were measured before treatment, immediately after treatment, and at 3 and 6 months after treatment, and RT-PCR and Western blotting were used to measure the mRNA and protein expression of ABCA1 in macrophages. Results The drug group and the electroacupuncture group had a significantly higher overall response rate than the control group (P<0.05). Immediately after treatment, the drug group and the electroacupuncture group had significant reductions in TG, TC, and LDL-C (P<0.05); compared with the control group, the drug group and the electroacupuncture group had significantly greater reductions in TG, TC, and LDL-C (P<0.05), while there were no significant differences in the changes in TG, TC, and LDL-C between the drug group and the electroacupuncture group (P>0.05). The electroacupuncture group had no significant changes in TC, TG, and LDL-C from immediately after treatment to 3 and 6 months after treatment (P>0.05), and the drug group had significant increases in TC, TG, and LDL-C from immediately after treatment to 3 and 6 months after treatment (P<0.05); these two groups still had significantly lower TC, TG, and LDL-C than the control group immediately and at 3 and 6 months after treatment (P<0.05). The drug group and the electroacupuncture group had significantly higher mRNA and protein expression of ABCA1 than the control group (P<0.05), while there were no significant differences in the mRNA and protein expression of ABCA1 between the two groups (P>0.05). Conclusion Electroacupuncture at Fenglong acupoint can reduce the levels of TC, TG, and LDL-C in hyperlipidemia patients and has a more stable clinical effect than drug therapy. It can also improve the mRNA and protein expression of ABCA1 in macrophages, promote reverse cholesterol transport, reduce cholesterol load in macrophages, and alleviate inflammatory response, and thus it can be used for the prevention and treatment of atherosclerotic cardiovascular and cerebrovascular diseases.