Background: Alcohol consumption is associated with increased high-density lipoprotein (HDL) cholesterol levels. One of the main antiatherogenic functions of HDL is reverse cholesterol transport. Three early steps of reverse cholesterol transport are (1) cellular cholesterol efflux, (2) plasma cholesterol esterification (EST), and (3) cholesteryl ester transfer (CET) to apolipoprotein B-containing lipoproteins. Our previous study in healthy middle-aged men showed that moderate alcohol consumption increases cellular cholesterol efflux and EST. This study investigated the effect of moderate alcohol consumption on three early steps of reverse cholesterol transport in postmenopausal women. Methods: In a randomized crossover study, 18 postmenopausal women-all apparently healthy, non-smoking, and moderate alcohol drinkers-consumed white wine or white grape juice with evening dinner during 2 successive periods of 3 weeks. During the white wine period, alcohol intake equaled 24 g/day. At the end of each of the two experimental periods, blood samples were collected. Results: Three weeks of alcohol consumption increased serum HDL cholesterol levels (5.0%; p < 0.05), serum HDL phospholipid levels (5.8%; p < 0.05), and the ex vivo cellular cholesterol efflux capacity of plasma, measured with Fu5AH cells (3.4%; p < 0.05). Plasma EST and CET did not change. Conclusions: Moderate alcohol intake increases serum HDL cholesterol level and stimulates cellular cholesterol efflux in postmenopausal women. Moderate alcohol consumption does not seem to affect two other early steps of reverse cholesterol transport at this level of alcohol intake. Our data suggest that the relative protection of moderate alcohol consumption against cardiovascular disease in postmenopausal women may involve the stimulation of reverse cholesterol transport through increased HDL.