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In response to various types of vascular stress, the smooth muscle cells of the vessel wall (VSMCs) change phenotype and acquire the capacity to react to abnormal signals. This phenomenon favors the involvement of these cells in the development of major vascular diseases, such as atherosclerosis, and some complications of angioplasty, such as restenosis. The cyclic adenosine monophosphate (cAMP) pathway plays a key role in the integration of stimuli from the immediate environment and in the development of cellular responses. The temporal and spatial subcellular compartmentalization of cAMP ensures that the signals transmitted are specific. This compartmentalization is dependent on the diversity of (1) proteins directly or indirectly regulating the synthesis, degradation or release of cAMP; (2) intracellular effectors of cAMP; (3) isoforms of all these proteins with unique biochemical properties and unique patterns of regulation and (4) the scaffolding proteins on which the macromolecular complexes are built. This review illustrates the ways in which changes in the profile of adenylyl cyclases (ACs) may play critical roles in signal integration, the response of muscle cells and pathological vascular remodeling. It also illustrates the relevance of the renewed consideration of ACs as potentially interesting treatment targets., (© Société de Biologie, 2016.)