Endothelial cells (ECs) line the quiescent vasculature but can form new blood vessels (a process termed angiogenesis) in disease. Strategies targeting angiogenic growth factors have been clinically developed for the treatment of malignant and ocular diseases. Studies over the past decade have documented that several pathways of central carbon metabolism are necessary for EC homeostasis and growth, and that strategies that stimulate or block EC metabolism can be used to promote or inhibit vessel growth, respectively. In this Review, we provide an updated overview of the growing understanding of central carbon metabolic pathways in ECs and the therapeutic opportunities for targeting EC metabolism.