Bioactive sphingolipids are engaged with numerous cellular processes such as cell differentiation, proliferation and apoptosis. Sphingolipid metabolism in heart is regulated by physical exercise and PPARs. Ceramide, the main second messenger of sphingomyelin pathway of signal transduction, was found to be involved in development of cardiac dysfunction after ischemia/reperfusion. On the other hand ceramide derivative sphingosine- 1- phosphate has been shown to exert potent cardioprotective action and guards cardiomyocytes against ischemic/reperfusion injury. Pharmacological compounds, which regulate metabolism of sphingolipids can be potentially useful in treatment of selected cardiovascular diseases. The aim of this work is critical review of physiological and pathological role of sphingolipids in circulatory system.