In recent years, the association between depression and cardiovascular disease has been studied extensively (Nicholson et al. 2006; Van der Kooy et al. 2007). Cardiovascular disease (CVD) refers to those conditions that affect the heart and blood vessels, including amongst others coronary heart disease, cerebrovascular disease, and peripheral artery disease. According to the World Health Organisation, cardiovascular disease now is the primary cause of death around the world. Depressive disorders enhance the development of CVD by both behavioural and biological pathways. They may contribute to unhealthy lifestyle habits that increase cardiovascular risk, such as smoking, low physical activity, and unhealthy diet. Also, this psychiatric condition is associated with activation of the immune system, blood coagulation, hyperactivity of the physiological stress system (e.g. hypothalamic pituitary adrenal axis), and other biological mechanisms which are thought to be involved in de development and progression of CVD. As these behavioural and biological factors are more continuously present in persons with chronic depression, it can be assumed that the risk of developing CVD is even higher in chronically depressed subjects, although this has not been clearly demonstrated yet. The first aim of this Chapter is to summarize what is known about the association between depression and vascular conditions. An overview of the literature will be given and a more detailed description of recent findings from a large Dutch cohort study on depression and anxiety (Seldenrijk et al. 2010; Seldenrijk et al. 2011b; Vogelzangs et al. 2010) will be presented. The second aim is to discuss the relevance of reviewed findings for chronic depression.