Atherosclerosis and its complications determine the majority of deaths in the western world, followed by malignant tumors. The present work introduces a classification of stages of atherosclerotic disease based on relevant pathogenic and therapeutic concepts, elaborated by H. Stary. At the present, we are able to relate different lesion types to a time course and partly to interferences between participating cell populations as well as to special pathogenic stimuli. From the therapeutic view, this knowledge is fundamental for preventive as well as interventional strategies like gene therapy. Distinct atherosclerotic plaques reveal a different composition and architecture, which may account for the variable risk for further complications of lesions showing the same size and degree of stenosis. In combination with an advanced clinical and diagnostic characterization of atherosclerotic lesions, the present concept might contribute to a better and differential therapy of atherosclerosis.