Coronary atherosclerosis is conditioned by structural changes of the arteries that develop starting from the first year of life and manifest in intimal muscular-elastic hyperplasia (IMEH). Lipid accumulation in IMEH may result in the fibrous-lipid plaques development without stage of the lipid spots. IMEH facilitates the development of grave arterial stenosis. Monocytes-macrophages of the subendothelial layer are the source of the foamy cells at the early manifestations of the intimal lipidosis. A characteristic feature of any stage of atherosclerosis is the development of focal necrosis in the altered intima which predetermines membranous calcinosis. Some mechanisms of atherosclerosis reversibility are considered.