Our aim in this study was to investigate the effect of aging on the capacity of HDLs to promote reverse cholesterol transport. HDLs were isolated from plasma of young (Y-HDL) and elderly (E-HDL) subjects. HDL-mediated cholesterol efflux was studied using THP-1 and J774 macrophages. Our results show that E-HDLs present a lower capacity to promote cholesterol efflux than Y-HDLs (41.7 6 1.4% vs. 49.0 6 2.2%, respectively; P 5 0.013). Reduction in the HDL-mediated cholesterol efflux capacity with aging was more significant with HDL 3 than HDL 2 (Y-HDL 3 , 57.3 6 1% vs. E-HDL 3 , 50.9 6 2%; P 5 0.012). Moreover, our results show that ABCA1-mediated cholesterol efflux is the more affected pathway in terms of cholesterol-removing capacity. Interestingly, the composition and structure of HDL revealed a reduction in the phosphatidylcholine-sphingomyelin ratio (E-HDL, 32.7 6 2.7 vs. Y-HDL, 40.0 6 1.9; P 5 0.029) and in the phospholipidic layer membrane fluidity in E-HDL compared with Y-HDL as well as an alteration in the apolipoprotein A-I structure and charge. In conclusion, our results shown that E-HDLs present a reduced capacity to promote cholesterol efflux, principally through the ABCA1 pathway, and this may explain the increase of the incidence of cardiovascular diseases observed during aging.-Berrougui, H., M. Isabelle, M. Cloutier, G. Grenier, and A. Khalil. Age-related impairment of HDL-mediated cholesterol efflux. J. Lipid Res. 2007. 48: 328-336.