Significance: Hydrogen sulfide (H 2 S) has traditionally been considered a toxic environmental pollutant. In the late 1990s, the presumed solely harmful role of H 2 S has been challenged because H 2 S may also be involved in the maintenance and preservation of cardiovascular homeostasis. Recent Advances: The production of endogenous H 2 S has been attributed to three key enzymes, cystathionine c-lyase (CSE), cystathionine b-synthase, and 3-mercaptopyruvate sulfurtransferase. The recognition of H 2 S as the third gaseous signaling molecule has stimulated research on a multitude of pathophysiologic events in the cardiovascular system. In particular, important roles in cardiovascular disorder processes are ascribed to the CSE/H 2 S pathway, such as atherosclerosis, myocardial infarction, hypertension, and shock. Critical Issues: Many biological activities and molecular mechanisms of H 2 S in the cardiovascular system have been demonstrated in studies using different tools, such as the genetic overexpression of CSE, the direct administration of H 2 S donors, or the use of H 2 S-releasing prodrugs. Unfortunately, the role of the CSE/H 2 S pathway in cardiovascular disease remains controversial in numerous areas, and many questions regarding the gaseous molecule still remain unanswered. Future Directions: Advances in basic research indicate that the CSE/H 2 S pathway may provide potential therapeutic targets for treating cardiovascular disorders. But the molecular targets of H 2 S still need to be identified. Antioxid. Redox Signal. 17, 106-118.