Chronic obstructive pulmonary disease (COPD) is an inflammatory disease of the lungs mainly caused by smoking and characterized by chronic airflow limitation. COPD is the fifth leading cause of death worldwide and up to 50% of COPD patients die of a cardiovascular event. Cohort studies demonstrated that airflow limitation is a predictor of cardiovascular risk, even after adjusting for known risk factors such as smoking and cholesterol levels. Various mechanisms of vascular damage have been suggested in COPD including systemic inflammation, hypoxia, oxidative stress, activation of the sympathetic nervous system and changes of the vascular connective tissue. The evidence of a causal relationship between COPD and cardiovascular disease is yet insufficient. Data from controlled trials investigating the postulated pathomechanisms are awaited with interest.