With the advent of the third millennium, a number of pathologies have been eradicated or taken under control. However, the incidences of cancer and atherosclerosis, the two most common causes of death in developed countries, have increased or, in some instances, only stagnated. Therefore there has been an intensive search for agents effective against such life-threatening conditions. Accordingly, the potential anti-atherogenic activity of vitamin E analogs has been studied extensively. Interestingly, recent reports strongly suggest that certain vitamin E analogs, represented in particular by alpha-tocopheryl succinate (alpha-TOS), also possess antineoplastic activity. In this communication, we review our current understanding of the molecular basis for these double effects of a-TOS and propose a testable hypothesis, according to which this semi-synthetic analog exerts both anti-atherogenic and antineoplastic activities. We propose that the prevalence of each activity depends on the actual form of the vitamin E analog. That is, the conversion of the pro-vitamin E form, alpha-TOS, to the corresponding vitamin form, alpha-tocopherol, makes this anti-neoplastic agent active against inflammatory diseases like atherosclerosis. (C) 2002 Elsevier Science (USA). All rights reserved.