Platelet endothelial cell adhesion molecule (PECAM-1) is a member of the superfamily of immunoglobulins. This cell adhesion molecule has been implicated to mediate the adhesion and trans-endothelial migration of T lymphocytes/monocytes into the vascular wall, a critical step in the initiation of atherogenesis. Current thinking, however, posits that PECAM-1 by virtue of being a scaffolding molecule may well play a role in several signal transduction reactions. As a consequence, this cell adhesion molecule may be responsible for several biological and pathophysiological functions such as thrombosis, and inflammation. Evidence has also been put forward for a potential role of PECAM-1 in apoptosis and atherosclerosis. This article focuses on the structure of PECAM-1 and its role in intracellular signaling and implications in health and disease.