Early lesions of arteriosclerosis are characterized by proliferating smooth muscle cells, macrophages,and foam cells. In addition, large amounts of connective tissue components and cholesterol esters are found. These changes are primarily located in the intima of the arterial wall. The initial mechanisms responsible for lesion formation are largely unknown. In recent years progress has been made particularly in fields of research related to the biochemistry of arterial wall cells in tissue culture. The findings obtained allow us to deepen our knowledge of the pathophysiology of arteriosclerosis. Of special interest are mechanisms involved in the maintenance of the thromboresistant endothelium, the factors triggering proliferation of intimal smooth muscle cells, and the transformation of macrophages to foam cells.