Peripheral atherosclerosis (carotid and aortofemoral vascular districts) shows some peculiar characteristics with respect to coronary atherosclerosis. In this paper we have reviewed the most recent studies on the relationships between atherosclerosis of the limbs and lipid metabolism. Several authors have described increased plasma levels of lipoprotein remnants, lipoprotein (a) and some lipid peroxidation parameters in extracoronary atherosclerosis, while HDL (and their subfractions) seem to be reduced. Some of these modifications may be related to the direct metabolic effects of smoking and diabetes, which frequently coexist. Recent intervention trials show a possible regression of established atherosclerotic plaques after hypolipidemic therapy. This further underscores the role of plasma lipoprotein pattern in determining peripheral vascular lesions.