HMG-CoA reductase inhibitors (statins) are effective lipid-lowering drugs widely used in patients with dyslipidemia at risk of cardiovascular diseases. Primary and secondary prevention studies have revealed a significant reduction of risk for cardiovascular diseases. However, recent studies have demonstrated that statins have direct vascular effects (pleiotropic effects) independent of lipid-lowering action. Vascular remodeling, defined as changes in size and / or structure of adult vasculature, not only allows physiological adaptation and healing but also underlines the pathogenesis of major cardiovascular diseases. Vascular remodeling can be inward, occlusive, and outward. Various cardiovascular diseases probably represent a terminal phenotype of such vascular remodeling. In this review, we will focus on the basic actions and clinical implications of statin therapy to each type of vascular remodeling in response to various stimuli.