Over the last quarter-century, numerous advances have been made in the understanding of the molecular and cellular processes that lead to the development of atherosclerosis. The respective roles of the endothelium, inflammatory mediators, and thrombosis in the pathogenesis of vascular disease are beginning to be better understood. As more is learned about the initiation of atherosclerotic cardiovascular disease, new targets for systemic therapies are being discovered. Several classes of medications have been shown to be beneficial in preventing adverse cardiovascular events in patients with cardiovascular disease. These medications include platelet inhibitors (aspirin and thienopyridines), angiotensin-converting enzyme inhibitors, and 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (“statins”).