Oxidative stress accelerates atherosclerosis mainly through oxidative effects, induction of altered vascular gene expression, and promotion of cell proliferation. 1. Oxidation: Oxidative stress at the vascular wall can oxidize LDL to produce oxidized LDL. ox-LDL can promote atherosclerosis by binding to but not to scavenger receptors in macrophages or by cytotoxicity. 2. Induction of vascular gene expression: Oxidative stress can induce changes in the expression of genes related to inflammation and atherosclerosis, such as vascular cell adhesion molecule-1, macrophage inflammatory protein-1 and monocyte chemotactic protein-1. 3. Cell proliferation: reactive oxygen species and ox-LDL produced by oxidative stress can stimulate smooth muscle cell and macrophage proliferation. The relationship between oxidative stress and atherosclerosis is complex, and mild oxidative stress also has an anti-atherosclerotic effect. Further research on the relationship between oxidative stress and atherosclerosis may become a therapeutic target for coronary heart disease and other diseases.