High density lipoprotein (HDL) is mainly composed of apolipoprotein A1 (ApoA1), lipid and related regulatory factors. Its structural and functional abnormalities are closely related to the occurrence and development of cardiovascular diseases. HDL mainly transports cholesterol from the macrophages under the endothelium of blood vessels to the liver and expels it through the reverse cholesterol transport pathway, regulating the lipid balance in the body. It is found that the structure and metabolism of HDL have changed in patients with cardiovascular disease, including the abnormal modification of ApoA1, serum amyloid A instead of ApoA1 and the change of miRNA content carried by HDL. This article reviews the structure, metabolism and function of HDL, which provides a new way for the diagnosis and treatment of lipid metabolism related diseases.