Gene therapy is suggested to be beneficial for the treatment of diseases which are difficult or impossible to be cured by classical pharmacotherapy. Thus, the transfer of genetic material of potential therapeutic properties may be particularly helpful in the treatment of hereditary genetic disorders and cancer. However, serious technical obstacles, especially the lack of efficient vectors for the delivery of therapeutic genes have so far prevented the achievement of convincing therapeutic effects. On the other hand, the complications of atherosclerosis, such as heart or peripheral ischaemia, seem to be good candidates for genetic strategies aimed particularly at stimulation of angiogenesis. As in this case therapeutic genes should be expressed locally and in a short time there is a good chance that the application of this therapy will take place earlier than in the case of other disorders. In this paper the first gene therapy clinical trials in human cardiovascular diseases are described. The latest investigations on the basic mechanisms of the blood vessel wall physiology and relationships between factors involved in angiogenesis are also briefly mentioned.