HDL protects against atherosclerosis development. Defective functioning of HDL in type 2 diabetes may be one cause of increased cardiovascular disease associated with type 2 diabetes. HDL modulates LDL oxidation through the action of paraoxonase-1 (PON1), which is one of the major mechanisms by which HDL is antiatherogenic. We have compared the ability of HDL from people with type 2 diabetes (n ؍ 36) with no coronary heart disease (CHD) to metabolize oxidized palmitoyl arachidonyl phosphatidylcholine (ox-PAPC), a major product of LDL oxidation and a PON1 substrate, with that of HDL isolated from healthy control subjects (n ؍ 19) and people with CHD but no diabetes (n ؍ 37). HDL from people with type 2 diabetes metabolized 11% less ox-PAPC, and HDL from people with CHD metabolized 6% less, compared with HDL from control subjects (both P < 0.01). The ability of HDL from control and type 2 diabetic subjects containing the PON1-192RR alloform to metabolize ox-PAPC was significantly reduced compared with PON1-192QQ or QR genotypes (P < 0.05). The defective ability of HDL to metabolize ox-PAPC was reflected in a significant increase in circulating plasma oxidized LDL concentration in the two patient groups (37 ؎ 5, 53 ؎ 7, and 65 ؎ 7 mmol/l for control, CHD, and type 2 diabetic subjects, respectively; P < 0.001), with PON1-192RR genotype carriers having the highest concentrations. In the control group, there was a significant negative correlation between serum PON1 activity and oxidized LDL concentration (r ؍ 0.856, P < 0.001); however, this correlation was not evident in the patient groups. HDL from type 2 diabetic subjects without CHD had a decreased ability to metabolize oxidized phospholipids, which could lead to increased susceptibility to develop cardiovascular disease. Diabetes 55: 3099 -3103, 2006 T he oxidation of LDL in the artery wall is believed to be the primary event leading to the initiation and progression of atherosclerosis (1,2). HDL, on the other hand, is protective against the development of atherosclerosis (3,4). The primary protective effect of HDL was believed to be its pivotal role in reverse-cholesterol transport; however, HDL also has antioxidative, anti-inflammatory, and antithrombotic properties (5).HDL-associated paraoxonase-1 (PON1) is primarily responsible for the antioxidative properties of HDL in retarding the oxidation of LDL (6 -10). By modulating the oxidation of LDL, PON1 abolishes the oxidized LDLstimulated induction of monocyte-chemotactic protein-1 (MCP-1) production by endothelial cells, thereby preventing monocyte-endothelial cell interaction in one of the earliest processes of atherosclerosis (11,12). PON1 is low in patients with diabetes (13-15), leading to dysfunctional HDL with impaired antioxidant capacity (15). In type 2 diabetes, there is an inverse relationship between PON1 activity and circulating oxidized LDL levels (16,17), indicative of the major role of PON1 in retarding LDL oxidation. We have recently shown that adenovirus-mediated overexpression of hu...