The composition of high density lipoprotein (HDL) is complex and its function is prone to change. Normal HDL is a protective lipoprotein, which can protect cardiovascular function. However, recent studies have found that HDL composition and function change not only in coronary heart disease, heart valve disease, aneurysm, heart failure, heart transplantation and other cardiovascular diseases, but also in the cardiovascular perioperative period. The HDL proinflammatory index in normal people is very low, but it becomes very high under the condition of cardiovascular disease, which impairs vascular endothelial function and affects the stability of hemodynamics after cardiac surgery. Apolipoprotein A-Ⅰ mimetic peptide and simvastatin can partially improve HDL function. Therefore, how to improve the function of HDL, and restore its protective cardiovascular effect to prevent cardiovascular diseases and enhance cardiovascular protection in perioperative period need to be studied in the future.