Atherosclerosis is currently appreciated as a disease with a large inflammatory component. The underlying mechanisms, which are uncovered in a rapid pace, are greatly interconnected and as such very complex. Nevertheless, for clinicians it is important have some degree of insight in these immunologic mechanisms in order to interpret the current research advances. The aim of this review is to supply clinicians with this knowledge, avoiding too much detail. All the relevant immunologic basics will be discussed at first, followed by the immunity related theories of atherosclerosis. Finally, current and new immune-modulatory therapies will be discussed.