Atherosclerosis is a chronic inflammatory disease, with both the innate and adaptive immune systems responding to many endogenous and exogenous antigens. Subsequent investigations have revealed that an immunomodulatory strategy via active immunization against atherosclerotic plaque antigen(s) could potentially alleviate atherosclerosis. Substantial data from clinical investigations support the key role of immune system in atherosclerosis. So, it may be promising to develop immunotherapy against atherosclerosis. The paper reviews current status of immunization studies and possible associated immunemediated inflammatory mechanisms in atherosclerosis.