The growth and survival of many cell types requires integrin-mediated adhesion to the extracellular matrix (ECM). Physiologically, the prerequisite of cell-ECM adhesion interaction for cell cycle progression and cell survival is likely to be important in tissue morphology and regression as a mechanism to regulate tissue architecture and cell number. Pathologically, anchorage-dependent survival may limit tumor invasion and metastasis. Endothelial cells are anchorage-dependent cells, and many ECM molecules interacting with different classes of integrins promote their survival. It has became clear, however, that during the angiogenesis process the alpha(v)beta(3) integrin plays a fundamental role in maintaining endothelial cell viability. The downstream signals regulating this process are becoming clarified, and new functions are described for molecules involved in apparently distant systems. (Trends Cardiovasc Med 2002; 12:83-88). (C) 2002, Elsevier Science Inc.