An increasing body of evidence has demonstrated that NADPH oxidase plays a critical role in several early steps leading toward the development of atherosclerosis. These effects appear to be carried out by both the ability of O2- to act as a small second messenger molecule, and potentially the oxidation of low density lipoprotein by O2-. We describe a model for the initiation and development of atherosclerosis that suggests targeted inhibition of NADPH oxidase as a powerful site for prevention and treatment of this disease.