Cardiovascular diseases are a heterogeneous group of diseases whish still remains a major health problem in the healthcare system. This review merely focuses on the issue of ischemic heart disease and it’s complications, but mentions other cardiovascular diseases in a shallow matter. The traditional way of treating coronary artery disease has involved pharmacological methods and revascularization through percutaneous coronary interventions (PCI) and bypass graft surgery. Not all patients are amendable to revascularization procedures, and would welcome alternative therapies. Many patients will with or without successful revascularization develop chronic hearth failure over time. This is a serious disease with generally bad prognosis. We will address a new treatment strategy; gene therapy, and it’s potential use as a therapeutic agent primarily for patients with ischemic heart disease, but also for patients with a variety of other cardiovascular diseases. The different vector systems for delivery of therapeutic genes are discussed, as well as their capability of targeting the myocardium in a highly specific way. Viral and non-viral vectors have their “pros and cons”, and these are considered in the overview. Potential target genes for therapy are also discussed, focusing primarily on genes affecting the process of angiogenesis and arteriogenesis, and especially hypoxia-inducible factor-1 (HIF-1) and the hypoxia-responsive genes it regulates. Choices of gene delivery methods are discussed.