The lysophospholipids sphingosine-1-phosphate (S1P) and lysophosphatidic acid (LPA) have varied effects on the cardiovascular system. S1P is necessary for normal vascular development and may play an important role in angiogenesis. These molecules may exert potentially detrimental effects. Both S1P and LPA are released from activated platelets and can in turn stimulate platelet aggregation. These thrombogenic effects would further enhance ischemia in acute coronary syndromes and myocardial infarction. LPA is a major component of the lipid core of human atherosclerotic plaques and can stimulate vascular smooth muscle proliferation. Both LPA and S1P cause cardiac myocyte hypertrophy in vitro. Beneficial effects include cardioprotection both in vitro and during ischemia/reperfusion in an ex vivo whole heart mouse model. Understanding both the acute and the chronic physiologic and pathophysiologic roles of the lysophospholipids and their cognate receptors and signaling pathways in the cardiovascular system, which are likely to be species-, tissue-, and cell-specific, may allow the development of molecules that can be targeted to stimulate or inhibit a specific function.