Multiple sclerosis (MS) is a chronic auto-immune disease. Most therapeutic strategies for treatment of this disease direct immune modulation and control of inflammatory processes. First-line therapeutic agents showed moderate efficacy and frequent side-effects with moderate efficacy in trials. Their parental administration and limited long-term adherence restrict their efficacy compared with second-line therapies. Fingolimod as a second-line therapeutic agent has been shown to reduce annualized relapse rate, risk of disability progression and inflammatory activity of relapsing MS. Safety and efficacy FTY720: Safety and efficacy issues are the main metrics for judgment of drug efficacy. In this article, we focus on cardiovascular effects of FTY720 treatment. Effect of FTY720 on rate and rhythm, impact of FTY720 on endothelial cells, its atheroprotective effects, its effects on cardiac transplantation outcomes, vascular complications of FTY720, effects of FTY720 on endocrine functions and interaction of FTY720 with cardioactive agents are explained in this review article.