Tumor necrosis factor (TNF)-alpha is a potent inducible cytokine with pleiotropic biological effects, now implicated as a mediator of various physiologic and pathophysiologic events including inflammation, cell survival, growth, differentiation and apoptosis. TNF-alpha functions within a complex and tightly regulated cytokine network, activating multiple signal transduction pathways and inducing or suppressing a wide variety of genes, including those encoding for other cytokines, adhesion molecules and the inducible nitric oxide synthase. TNF-alpha has recently been implicated as a transducer of cardiovascular diseases, namely coronary artery disease and congestive heart failure. This review will summarize established and newer findings on this molecule.