Since the discovery of oxidized low density lipoprotein (Ox-LDL), over 5,000 articles have appeared on the topic with over 400 articles appearing every year during the past decade. LDL contains esterified polyunsaturated fatty acid containing lipids, such as, phosphatidylcholine (PtdCho) and cholesterol esters (CE). Peroxidation of polyunsaturated fatty acid (PUFA) containing lipids has been known for a long time. Numerous studies have documented that peroxidized lipids as well as products derived from their decomposition, particularly aldehydes, have deleterious biological properties. This concept has been exemplified in the study of atherosclerosis. A plethora of in vitro and animal studies, as well as human epidemiological and correlatory studies, have supported the notion that oxidative processes and the formation of Ox-LDL might contribute to atherosclerosis. Yet the negative outcomes of human clinical trials with α-tocopherol and other antioxidants have convinced even staunch supporters of the hypothesis to take a step backwards and reconsider reasons of their failure and suggest alternative approaches. Ox-LDL is a complex mixture of numerous chemical entities, many of them are yet uncharacterized. Why and how it is formed or its nature in vivo is poorly understood. It is recognized by numerous cell surface receptors, which are ubiquitously expressed in many different cell types. These receptors might perform a variety of functions. In addition, components of Ox-LDL might also have favorable effects that are difficult to dissociate from its pathological effects. In this review, the nature of Ox-LDL and potential problems in inhibiting its formation are discussed.