To assess the efficacy and safety of acupuncture for hyperlipidemia in adults. Methods: We searched electronic databases, including PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, CBM, CNKI, and VIP. All included studies were assessed in terms of quality and risk bias. The Review Manager 5.3.3 software was used for the data analyses, and the GRADE profiler software was applied to classify the systematic review results. Results: Seventeen studies were identified (n = 1,408). Acupuncture (electro-acupuncture or magnetic needle) was equally as effective as sham treatment (needle acupuncture) (relative risk [RR], 0.95; 95% confidence interval [CI], 0.72-1.24). Acupuncture (needle acupuncture, electro-acupuncture, moxibustion, and acupoint catgut embedding) was as effective as statin therapy (RR 0.10; 95%CI, 0.97-1.24). Acupuncture was as effective as Chinese herbal preparations (electro-acupuncture and auricular acupoint) (RR, 0.97; 95%CI, 0.89-1.06). However, insufficient evidence was available to demonstrate whether acupressure was effective compared with acupuncture plus other treatments (RR, 1.04; 95%CI, 0.87-1.25). Conclusion: Acupuncture may improve hyperlipidemia levels. However, additional large, properly randomized, placebo-controlled, double-blind studies are required.