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Vascular endothelial growth factor (VEGF), a potent growth factor for endothelial cells and inducer of angiogenesis, is important for endothelial integrity and thus for vascular function. On the other hand, VEGF may enhance the pathophysiologic mechanism of plaque formation and plaque destabilization. In this review we discuss the data available so far for VEGF as angiogenic and/or inflammatory cytokine in the vulnerable atherosclerotic plaque.