There are several potential mechanisms by which HDLs protect against atherosclerosis. One relates to the ability of HDLs to promote the efflux of cholesterol from macrophages. Another is the ability of HDLs to inhibit one of the earliest events in the development of atherosclerosis, namely the expression of vascular cell adhesion molecules in activated endothelial cells. This property has been reported in vitro in studies with both native and reconstituted HDLs. The inhibitory activity of reconstituted HDLs is influenced by the phospholipid composition of the particles. An inhibition of endothelial cell adhesion molecule expression has also been observed in some (but not all) studies conducted in vivo in mice and pigs. The mechanism of this potentially anti-atherogenic effect of HDLs remains uncertain, as does its contribution to the cardioprotective effects of HDLs in vivo.