Developing drugs to treat atherosclerosis is a daunting task. However, recent studies of advanced human atherosclerotic lesions have yielded new information on potential mechanisms of inflammation and immune responses in late-stage human atherosclerosis. As leukotrienes (LTs) are among the most powerful inflammatory mediators known and because the 5-lipoxygenase pathway is expressed in diseased arteries, the roles of LTs in atherogenesis merit consideration. It is also of interest to consider pharmacological strategies to develop anti-LT drugs in atherogenesis.