There is growing evidence that heat shock proteins (HSP), a family of stress-inducible proteins may be involved in the pathogenesis of atherosclerotic vascular diseases. Here we systematically review the evidence behind this notion. A detailed literature search and extensive bibliographic review of literature relating to HSP and atherosclerotic vascular disease. Atherosclerotic vascular disease is classified into four main areas of presentation: carotid, coronary, aortic and peripheral vascular disease, for consideration in this review. In each of these vascular diseases, the evidence linking HSP and atherosclerosis is outlined in a systematic manner. Current evidence suggests that components of the immune system may be involved in the pathogenesis of atherosclerosis, with HSP acting as auto-antigens in the immune response. HSP are detected in atherosclerotic lesions and antibodies to HSP are increased in patients with vascular disease; the rise often correlating with the severity of atherosclerosis. The levels of anti-HSP antibodies have been shown to be independent predictors of risk and have prognostic value. There is a strong link between heat shock protein expression and the principal manifestations of atherosclerotic vascular diseases. A better understanding of this involvement could lead to the development of new and improved treatment strategies