Morbidity and mortality attributed to diseases of the heart and blood vessels are growing steadily around the globe, as a result of changing lifestyles and increased longevity. Even in affluent countries many patients with cardiovascular syndromes do not benefit from current conventional therapies. Failure of drugs, catheter-based, and surgical interventions leaves millions of patients in a great need for new therapies. Cell and gene therapy hold great promise for cardiovascular therapies. As most cardiovascular pathologies are confined to a specific organ and are associated with arterial occlusion or muscle damage, both may be amenable to local cell and gene therapies. Local delivery of genes or cells that can promote the formation of new blood vessels (angiogenesis) or lead to tissue regeneration should be achievable with current knowledge and molecular technologies. So far, however, the promise of gene and cell therapy has not fulfilled the expectations. Nevertheless, careful review of the work and of current thinking in the field leaves room for optimism that gene and cell therapy may reach the clinical setting in the near future, providing a new option for many patients. In this paper, we review clinical studies of gene and cell therapy and discuss their impact on future research.