Why is HDL‐cholesterol good cholesterol?

Abstract The well recognized ability of high density lipoprotein (HDL) cholesterol, sometimes called good cholesterol, to protect against the risk of developing of cardiovascular disease requires an explanation. Such an explanation may be the role that HDL plays in the process of reverse cholesterol transport as practised by cells of the arterial wall such as the macrophage. Unwanted cholesterol is transported out of the macrophage and is accepted by HDL and then esterified. The resultant cholesterol esters are then transported to the liver either directly by HDL or indirectly by other lipoproteins which acquire the cholesterol esters from HDL in exchange for other lipids. The liver can then excrete the cholesterol into the bile as such or after conversion into bile acids. However, this may soon prove to be a limited view as HDL may also have anti‐inflammatory and anti‐coagulant effects which will contribute to its ability to protect against CVD.