In this lecture I would like to discuss the role of inflammation in the aetiology of coronary heart disease. I will attempt to explain some of the confusions relating inflammation and infection to the pathogenesis of atherosclerosis and will go on to discuss contribution of the insulin resistance syndrome to cardiovascular risk. I will point out that insulin resistance for some reason seems to be associated with the number of phenotypes taking to account the known mechanisms of action of insulin and propose the links both to inflammation and to endothelial damage point to the existence of the common antecedent. My final theme will be that potential suggest that proinflammatory cytokines generated from adipose tissue may play such an antecedent role.