A therosclerosis is a chronic and multifactorial disease mediated by complex interplay between resident endothelial cells, vascular smooth muscle cells (VSMCs), and infiltrating macrophages. Environmental exposure to risk factors such as hyperlipidemia throughout the development of atherosclerosis causes vascular remodeling and in turn reduces arterial compliance. Although many drugs inhibiting vascular remodeling and metabolic disorder offer an effective therapeutic strategy for preventing atherosclerotic progression, none of these drugs are found to totally reverse atherosclerotic plaque in animal experiments.1,2 Furthermore, clinical trials have revealed that intensive lipid-lowering treatment with rosuvastatin or atorvastatin only leads to limited plaque regression (1.22% and 0.99%, respectively), 3,4 although routine statin treatments can significantly reduce >30% of the risk of major adverse cardiac events such as myocardial infarction. [5][6][7][8][9] The memory effects of atherosclerosis imply that the mechanisms for atherogenesis are partially independent of the risk factors. It seems that atherosclerosis would progress at its own pace, once the atherosclerotic plaques are formed. Epigenetic modifications refer to heritable changes in gene expression that are not coded in the DNA sequence itself. Studies demonstrate that epigenomic changes in tissues and cells play important roles in vascular remodeling and atherosclerosis.10 DNA methylation is the most understood epigenetic modification. The effect of DNA methylation on gene expression can persist even if the risk factors are removed. In eukaryotic genomes, DNA methyltransferases (DNMTs) catalyze the conversion of cytosines, predominantly in cytidine phosphate guanosine (CpG) dinucleotides, to 5-methylcytosine (5-mC), and then silence gene expression. The DNMT inhibitor 5-aza-2′-deoxycytidine (5-aza) is © 2016 American Heart Association, Inc. Objective-DNA methylation plays an important role in chronic diseases such as atherosclerosis, yet the mechanisms are poorly understood. The objective of our study is to indicate the regulatory mechanisms of DNA methylation in vascular smooth muscle cells (VSMCs) and its roles in atherosclerosis. Approach and Results-In ApoE −/− mice fed a Western diet, DNA methyltransferase inhibitor, 5-aza-2′-deoxycytidine, significantly attenuated atherosclerotic lesions (20.1±2.2% versus 30.8±7.5%; P=0.016) and suppressed DNA methyltransferase activity and concomitantly decreased global 5-methylcytosine content in atherosclerotic lesions of ApoE −/− mice. Using a carotid ligation model, we found that 5-aza-2′-deoxycytidine also dramatically inhibited neointimal formation (intimal area: 2.25±0.14×10 4 versus 4.07±0.22×10 4 μm 2 ; P<0.01). Abnormal methylation status at the promoter of ten-eleven translocation 2, one of the key demethylation enzymes in mammals, was ameliorated after 5-aza-2′-deoxycytidine treatment, which in turn caused an increase in global DNA hydroxymethylation and 5-hydroxymethylcytosine enrichment at the p...