The present study describes the toxicity of oxidized LDL towards rabbit aortic endothelial cells in terms of its lipid components with specific attention to the cholesterol oxidation products (ChOx) found in oxidized LDL isolated from human plasma. Measurements of the major ChOx associated with freshly isolated unmodified LDL, those found in oxidized LDL isolated from human plasma and LDL subjected to oxidation in vitro are described. We have confirmed previous findings that most of the cytotoxicity of freshly isolated human LDL may be attributable to a minor fraction that appears to be oxidatively modified by several criteria. Moreover, this plasma-derived oxidized LDL (referred to as LDL) is highly enriched in ChOx, whereas the content of lipid peroxides or derived products (measured as conjugated dienes and thiobarbituric acid reacting products) are much lower, particularly when compared to copper-induced LDL oxidation. Much of the ChOx found in plasma are associated with LDL, however, the levels and proportions of the various ChOx found in LDL differ from those produced after extensive copper-induced oxidation but resemble those produced after moderate oxidation with copper. The species and concentrations of ChOx found in LDL when applied as a mixture exhibit considerably more toxicity than any individual ChOx alone. At non-toxic levels this ChOx mixture causes an increased influx of several ions, including calcium, an effect not seen with individual ChOx at comparable doses. Perturbations in ionic homeostasis, and particularly the sustained increase in intracellular calcium concentrations, are associated with much of the cytotoxicity, an effect attributable to the membrane disruptive action of ChOx leading to altered ion transporter activity. The effect of the ChOx mixture (but not any individual ChOx) on sodium and potassium flux appears to be due to enhanced Na+/K(+)-ATPase activity based on the complete inhibition produced by ouabain under all treatment conditions. These findings also show that the levels of cholesterol oxidation products found in normal LDL are not cytotoxic whereas those present in oxidized LDL exceed the toxic threshold for endothelial cells and account for most of the cytotoxicity produced by this modified lipoprotein.