Long thought of as a bystander in pathophysiological processes, lipid molecules have emerged as bioactive mediators of cardiovascular pathology. There has been accumulating evidence from both in vivo and in vitro studies that demonstrate an important role for oxidized phospholipids (oxPLs) in cardiovascular pathology. OxPLs represent a heterogeneous group of compounds that are generated during enzymatic and nonezymatic inflammatory processes. From their early discovery as a platelet-activating factor analog in the mid 1990s, there have been close to 50 different oxPL molecules identified that modulate pathological processes within the cardiovascular system. From large clinical studies, we have learned that oxPL/apoB levels can be a prognostic indicator that can predict future vascular events and that increased levels of oxPL increases platelet reactivity in patients with coronary artery disease. In this review, we will highlight the current understanding of oxPLs in cardiovascular pathology.