Insomnia is the most prevalent sleep disorder in the United States and is highly comorbid with a number of cardiovascular diseases. In the last decade a number of observational studies have demonstrated an association between insomnia and incident cardiovascular disease (CVD) morbidity and mortality, including hypertension, coronary heart disease, and heart failure. Despite some inconsistencies in the literature, likely due to variation in how insomnia is defined and measured, the existing data suggest that insomnia, especially when accompanied by short sleep duration, is associated with increased risk for hypertension, coronary heart disease and recurrent acute coronary syndrome, and heart failure. Purported mechanisms likely relate to dysregulation of the hypothalamic pituitary axis, increased sympathetic nervous system activity, and increased inflammation. This paper reviews the most recent studies of insomnia and CVD, the potential pathophysiologic mechanisms underlying this relationship, and highlights the need for randomized trials to further elucidate the nature of the relationship between insomnia and CVD.