Low levels of alpha tocopherol have been associated with increased risk for coronary artery disease and increased intake has been shown to be protective. Data support a proatherogenic role for oxidized LDL in atherosclerosis and several studies show that alpha tocopherol decreases the susceptibility of LDL to oxidation. In addition, alpha tocopherol can partition in the artery wall in critical cells such as smooth muscle cells, monocyte‐macrophages, endothelial cells, and platelets, exerting beneficial effects. In this review, the anti‐atherogenic effects of alpha tocopherol on crucial cells in atherogenesis have been highlighted, such as the inhibition of smooth muscle cell proliferation, preservation of endothelial function, inhibition of monocyte‐endothelial adhesion, inhibition of monocyte reactive oxygen species and cytokine release, and inhibition of platelet adhesion and aggregation. Curr Opin Lipidol 9:11–15. © 1998 Rapid Science Ltd