Macrophage cholesterol efflux is a central step in reverse cholesterol transport, which helps to maintain cholesterol homeostasis andto reduce atherosclerosis. Lipophagy has recently been identified as a new step in cholesterol ester hydrolysis that regulates cholesterolefflux, since it mobilizes cholesterol from lipid droplets of macrophages via autophagy and lysosomes. In this review, we brieflydiscuss recent advances regarding the mechanisms of the cholesterol efflux pathway in macrophage foam cells, and present lipophagyas a therapeutic target in the treatment of atherosclerosis.