It is well known that atherosclerosis is closely related to lipoprotein metabolism, particularly to the low density lipoprotein (LDL). LDL becomes atherogenic after undergoing oxidation by vascular cells, that transform them into highly bioreactive oxidized LDL (oxLDL). oxLDL is generally though to be involved in foam cell formation, and trigger an array of proatherogenic events. However, there are accumulating evidences that low levels of oxLDL can be atheroprotective through its cytoprotection, modulation of immunity and activation of reverse cholesterol transport. Thus, oxLDL may exert biphasic effects on atherosclerosis, just like a doubled-edged sword.