Atherosclerosis is the cause of most heart attacks and strokes, and is par excellence, a disease of ageing. Whilst disease prevalence and incidence increases with increasing decade of life, there is also evidence of accelerated cellular ageing in atherosclerosis. Such evidence includes impaired cell proliferation, early culture senescence and cell cycle markers of senescence in vitro and in vivo. Cell senescence is also characterised by loss of telomeres from the ends of chromosomes. Cellular ageing increases with disease severity, acting as a marker for disease, but also directly promotes atherosclerosis. Cellular ageing appears to be due to both abnormal proliferation of cells in an attempt to repair vessel damage, and a response to the damage itself. This review summarises the evidence of vascular cell senescence in atherosclerosis, the causes and consequences of accelerated cellular ageing in atherosclerosis, and identifies potential therapeutic options for both prevention and treatment.