The purpose of this review is the analysis of the molecular mechanisms of lipid metabolism, their disorders leading to atherosclerosis, and the influence of modern antiatherogenic and antihyperlipidemic agents on atherogenic mechanisms. At the beginning of the review, a general description of atherosclerosis as pathology, its main characteristics and factors is given. The question of the complexity of the treatment of atherosclerosis and the problems arising in connection with the complexity is considered. Current models of the nature of atherosclerotic lesions are described. Next, we consider modern anti-atherosclerotic drugs used in clinical practice. Their nomenclature is given. Their basic biochemical mechanisms and the nature of their action are analyzed. Their negative effects and side effects are also considered. Then, the molecular and genetic mechanisms associated with atherosclerosis are analyzed in detail. The genes associated with lipid metabolism and the formation of atherosclerotic plaques, their expression and regulation are considered. The question of the influence of known anti-atherosclerotic agents on their expression is also covered. A group of azole drugs and their effect on lipid metabolism are considered in the context of the search for new anti-atherogenic drugs. The final part of the review examines the relevance of the search for new anti-atherosclerotic agents and methods for modeling dyslipidemia as a model of conditions that correlate with anti-atherosclerotic vascular lesions. It was concluded that the search for antiatherogenic drugs among imidazole derivatives is promising.