Atherosclerosis and its complications (myocardial infarction, stroke, and gangrene of the extremities) remain the most common cause of death and disability worldwide. The World Health Organization estimates that 36% of all deaths will result from vascular disease by the year 2020. Atherosclerotic lesions often develop for decades before causing symptoms because of the tremendous plasticity of the artery wall. Atherosclerosis is a multi-factorial disease with many genetic factors involved, many theories proposed to explain the pathogenesis of atherosclerosis. The genetic basis of the disease assumes significance as candidate genes are identified and gene therapy becomes a promising new addition to the existing, less substantial conventional therapies. Gene therapy represents a unique and powerful tool that can be used to increase the success of surgical interventions, thereby substantially improving the lives of surgical patients.