Lecithin-cholesterol acyltransferase (LCAT) is a key enzyme that catalyzes the esterification of free cholesterol in plasma lipoproteins, and plays a critical role in high density lipoprotein (HDL) metabolism and the reverse cholesterol transportation. Although the LCAT study has been carried out for half a century, the relationship between LCAT and atherosclerotic cardiovascular disease is still controversial. In this paper, a review is made on the biochemical characteristics of LCAT, action mechanism of LCAT in lipid metabolism, relationship between LCAT and cardiovascular disease, existence problems in the accurate measurement of LCAT.