Survivin is a protein member of the inhibitor of apoptosis family that has attracted attention for its dual essential roles in the regulation of cell division and the control of apoptosis. Although extensively characterized as a tumor gene and exploited for new opportunities in cancer diagnostics and therapeutics, fresh experimental evidence has uncovered a critical role of survivin in vascular cell responses in vivo. Dynamically embedded in broad signaling pathways controlling smooth muscle cell adaptation, survivin not only controls vascular wall homeostasis but also acts as a critical upstream regulator of gene expression and second mediators.