This chapter discusses statin pharmacology, reviews evidence for statin pleiotropy in the clinical setting, and describes the cellular effects of statins in a variety of cell types and diseases. Cardiovascular disease, including heart disease, is the leading cause of mortality worldwide. The relevance of statin pleiotropy, however, remains unsettled due to lack of direct proof in cardiovascular clinical trials. Molecularly, the cardioprotective effects of statins in the myocardium may involve the RhoA/Rho kinase pathway. Direct evidence from animal and cell-culture studies and indirect inferences from clinical trials suggests that statins may exert a plethora of pleiotropic effects on the cardiovascular system. Proliferation of vascular smooth muscle cells is a key event in vascular proliferative diseases, including post-angioplasty/post-stent restenosis, transplant arteriosclerosis, and venous graft occlusion. The T cells that are recruited and activated in atherosclerotic lesions further mediate lesion growth and disease pathogenesis.