The presence of cholesterol crystals (CCs) in tissues was first described more than 100 years ago. CCs have a pathogenic role in various cardiovascular diseases, including myocardial infarction, aortic aneurysm and, most prominently, atherosclerosis. Although the underlying mechanisms and signalling pathways involved in CC formation are incompletely understood, numerous studies have highlighted the existence of CCs at various stages of atheroma progression. In this Review, we summarize the mechanisms underlying CC formation and the role of CCs in cardiovascular disease. In particular, we explore the established links between lipid metabolism across various cell types and the formation of CCs, with a focus on CC occurrence in the vasculature. We also discuss CC-induced inflammation as one of the pathogenic features of CCs in the atheroma. Finally, we summarize the therapeutic strategies aimed at reducing CC-mediated atherosclerotic burden, including approaches to inhibit CC formation in the vasculature or to mitigate the inflammatory response triggered by CCs. Addressing CC formation might emerge as a crucial component in our broader efforts to combat cardiovascular disease.

胆固醇晶体 （CC） 在组织中存在最早是在 100 多年前被描述的。CCs 在各种心血管疾病中具有致病作用，包括心肌梗塞、主动脉瘤，尤其是动脉粥样硬化。尽管 CC 形成所涉及的潜在机制和信号通路尚不完全清楚，但许多研究强调了 CC 在动脉粥样硬化进展的各个阶段的存在。在本综述中，我们总结了 CC 形成的机制以及 CCs 在心血管疾病中的作用。特别是，我们探讨了各种细胞类型的脂质代谢与 CC 形成之间的既定联系，重点是脉管系统中 CC 的发生。我们还讨论了 CC 诱导的炎症是动脉粥样硬化中 CCs 的致病特征之一。最后，我们总结了旨在减少 CC 介导的动脉粥样硬化负担的治疗策略，包括抑制脉管系统中 CC 形成或减轻 CCs 引发的炎症反应的方法。解决 CC 形成可能成为我们更广泛地对抗心血管疾病努力的重要组成部分。