Recent insights into the pathogenesis of cardiovascular disease have created the background for development of molecular therapies, and somatic gene transfer and use of antisense oligonucleotides are among the exciting new technologies in this field of research. Gene transfer into the cardiovascular system can be achieved by non-viral or viral vectors, and the latter (i.e., recombinant retrovirus or adenovirus) have the greatest efficacy in vivo. There are several potential clinical applications of gene therapy in cardiovascular disease, and interest has focused on restenosis after angioplasty, critical limb ischaemia, venous bypass graft occlusion, myocardial infarction, and familial hypercholesterolaemia. Favourable results of gene therapy and/or antisense strategies have been reported in experimental models, and these approaches show considerable promise for the treatment of human cardiovascular disease. However, definite clinical efficacy remains to be demonstrated in any gene therapy protocol, and there are many unresolved issues before gene therapy is likely to be implemented in the cardiovascular clinical practice.