The cardiovascular system is a target organ for GH and IGF-I. This review summarizes the role of the GH deficiency and GH replacement on the cardiovascular system. Patients with hypopituitarism have a reduced life expectancy due to cardio-vascular and cerebrovascular diseases. Women have a greater mortality than males. Adult patients with GH deficiency (GHD) have cardiovascular abnormalities such as reduced cardiac mass, diastolic filling and left ventricular response at peak exercise, increased intima-media thickness (IMT) and endothelial dysfunction. They also have increase in inflammatory markers. Long-term GH replacement therapy partially reverses  all cardiovascular abnormalities. In particular, cardiac size has been reported to increase during the first year of GH replacement and remains stable afterwards. Exercise performance and cardiac performance increase after GH replacement but data available after 12 months do not show normalization of these parameters. IMT at major arteries also decreases after GH replacement and in some, but not all, studies returns to values comparable to the general population. It is, however, still not fully elucidated if the GH-replacement beneficial effects on the cardio-vascular system completely restore life expectancy up to the general population. GH replacement reverses (or at least stops) cardiovascular abnormalities.