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A vast literature has explored arteriosclerosis, yet many aspects of its pathogenesis and the mechanisms behind the development of vascular lesions remain poorly understood. Recent advancements have significantly enhanced our understanding of the earliest stages of this condition, allowing us to relate morphological changes to functional disturbances. Notably, the analysis of arterial wall components, such as the endothelium and vascular smooth muscle, has shed light on their dysfunction. This has improved our comprehension of the interactions among various morphological components of the vascular wall and between the arterial wall and flowing blood. Key relationships, including those between platelets and endothelium, the coagulation system, granulocytes, and the endothelial cell layer, as well as the migration of blood cells into the subendothelial space, have been better described. The recognition of these functional and morphological disturbances has gained clinical significance due to the epidemic scale of arteriosclerotic diseases. Furthermore, the development of new drugs that target the atherogenic process offers hope for preventing disease progression and inhibiting complications in existing arteriosclerotic lesions.