In a cohort of healthy volunteers, cholesterol efflux capacity was correlated with carotid intima–media thickness. In a cohort of patients with or without angiographically confirmed coronary disease, cholesterol efflux capacity predicted coronary disease status. A robust inverse association between the level of high-density lipoprotein (HDL) cholesterol and the risk of cardiovascular disease has fostered intensive research seeking to target HDL metabolism for therapeutic gain. 1 , 2 However, some findings have called into question the hypothesis that pharmacologic increases in HDL cholesterol levels are necessarily beneficial. Several therapies, including nicotinic acid and fibric acid derivatives, increase HDL cholesterol levels, but linking these increases to clinical risk reduction has proved challenging. 3 , 4 Most strikingly, an inhibitor of cholesteryl ester transfer protein (CETP) was associated with an increase in the number of cardiovascular events, despite a 72% increase . . .