This article is available online at http://www.jlr.org hallmark of atherosclerosis. Similar changes are present in chronic metabolic diseases (hypercholesterolemia, insulin resistance, diabetes, etc.) ( 4 ), and have been described in other disorders such as cancer ( 5-9 ) and infections ( 10 ). Probably, accumulation of CEs serves as a reservoir of cholesterol for an enhanced membrane biogenesis during sustained proliferation.During acute infections the body undergoes several metabolic changes ( 11,12 ), among which plasma lipid alterations are prominent and related to a shift in energetic requirements (increased triglycerides and fatty acids) ( 13,14 ) or to structural modifi cation of LDLs ( 15 ) and HDLs ( 16,17 ). The infection-related decrease in C-HDLs observed in all species is ascribed to a reduction of proteins involved in reverse cholesterol transport ( 18,19 ), supposedly induced by infl ammatory molecules secreted from immune cells activated by the microbial stimulus ( 16 ). Thus, during infection, an ineffi cient removal of cholesterol from the arteries may contribute toward eliciting a lipid overload of macrophages and transformation of the former into foam cells ( 19 ). For this reason, infections have been considered as a serious risk factor for the development or worsening of atherosclerosis (20)(21)(22). Epidemiological fi ndings support this correlation, with acute vascular accidents (myocardial infarction, ictus, etc.) being described during acute and chronic infections. Carotid plaques have been observed in patients with periodontal diseases ( 23, 24 ) and other chronic infections ( 25,26 ).