Abstract-The arterial wall in aged animals shows an increased susceptibility to develop atherosclerotic lesions, although the mechanisms by which aging acts are still unclear. We investigated early aortic lesions in aged rabbits (5 to 6 years old, AH group) and young rabbits (2 months old, YH group) after 2 months of 0.2% cholesterol feeding. Fatty streaks or spots mainly in the proximal segments occupied a relative surface area that was greater in AH than in YH rabbits, although plasma cholesterol and lipoprotein levels did not differ. YH lesions showed an irregular endothelial profile mainly from accumulations of large, rounded, RAM 11-positive macrophagic foam cells. There was a higher percentage of myocytic, CD-5-positive, proliferating, and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL)-positive cells and larger accumulation of glycosaminoglycans in AH fatty streaks than in YH lesions. Ligation-mediated polymerase chain reaction confirmed differences in apoptosis. Early fibromuscular coats and subendothelial plasma-like insudate were also observed in AH lesions. Aged-matched normocholesterolemic rabbits showed a diffuse aortic intimal thickening composed of myocytic cells with a synthetic phenotype and extracellular matrix rich in glycosaminoglycans. In addition, in aged rabbits, we observed a spontaneous increase of monocytes adhering to the endothelial surface and a reduced expression of endothelial nitric oxide synthase in areas distant from the branches. These plasma cholesterol-independent spontaneous changes in the aortic wall of aged rabbits seem to act as a multiple atherogenic risk factor. Moreover, age-related differences in the distribution, composition, and proliferative and apoptotic rates represent crucial events during the progression of early fatty streaks to advanced plaques. Key Words: atherosclerosis Ⅲ aging Ⅲ smooth muscle cells Ⅲ glycosaminoglycans Ⅲ endothelial nitric oxide synthase T he outset of severe or advanced fibroatheromatous plaques is a late event and represents the final result of a slow and complex phenomenon. 1,2 Human and animal studies suggest that atherosclerotic plaques begin as early lesions or fatty streaks, 2,3 although the mechanisms responsible for this progression are still unclear. In fact, advanced plaques are generally encountered after the fourth or fifth decade of life, 2,4 and their development is at first related to the chronic exposure of the arterial wall to exogenous risk factors, 1 in particular to hypercholesterolemia. 5 In rabbits receiving a hyperlipemic diet, the pattern of atherosclerotic lesions depends on cholesterol content 6 and duration of the diet. 7 In particular, a low-dose hypercholesterolemic diet, even when extended for a long period of time, induces the development of fatty streaks. 6 In addition to dietary habits, endogenous or intrinsic factors have been also considered in the pathogenesis of atherosclerosis. On the basis of the high incidence of cardiovascular disease in elderly people, McGill et al 8 ...