Moderate ethanol intake consistently has been associated with a decreased risk of cardiovascular disease (CVD) in observational studies [1-3], although the decrease is most pronounced and consistent for coronary heart disease [1] and less so for stroke [1]. Although a few studies have shown increases [4] or no changes [5] in carotid atherosclerosis by ultrasound (carotid intima-media thickness, CIMT) with moderate ethanol intake, most have reported decreased CIMT in men but curiously no change in women [6-8]. Heavy ethanol intake appears to have adverse effects on CIMT [9, 10]. Ethanol appears favorably to affect many risk factors for atherosclerosis and CVD, including antithrombotic/anticoagulant factors (see ref. [11] for a review) and antiinflammatory factors (see ref. [12] for review). The best-studied effect, however, is an increase in plasma concentrations of high density lipoprotein (HDL), and it is estimated that about half of the relationship between ethanol and CVD may be attributed to its effects on HDL [3, 12]. For these reasons, the effects of ethanol on HDL metabolism, as outlined in this chapter, are of clinical, as well as research interest.