There has been much progress in the clinical treatment of Progressive Vascular Diseases (PVD) since the introduction of statins, calcium channel blockers, and other relevant drugs. Yet long term PVD still plagues much of our aged population. The use of gene therapy, delivering therapeutic transgenes, should provide both long-term and safe treatment, as well as more physiologically relevant treatments. Adeno-associated Virus (AAV) can provide long term and safe gene delivery, very appropriate for long term PVD. In regards to therapeutic transgenes for the treatment of PVD, there is the choice of several gene categories, all of which may provide a significant level of efficacy yet have different metabolic modes of action. As examples there are anti-inflammatory cytokine genes, blood lipoproteinmetabolism genes, and anti-oxidant genes.