Aims Monocytes are central for atherosclerotic vascular inflammation. The human non-classical, patrolling subtype, which expresses high levels of CD16 and fractalkine receptor CX3CR1, strongly associates with cardiovascular events. This is most marked in renal failure, a condition with excess atherosclerosis morbidity. The underlying mechanism is not understood. This study investigated how human CD16+ monocytes modulate endothelial cell function. Methods and Results In patients with kidney failure, CD16+ monocyte counts were elevated and dynamically decreased within a year after transplantation, chiefly due to a drop in CD14+CD16+ cells. The CX3CR1 ligand CX3CL1 was similarly elevated in the circulation of humans and mice with renal impairment. CX3CL1 upregulation was also observed close to macrophage rich human coronary artery plaques. To investigate a mechanistic basis of this association, CD16+CX3CR1HIGH monocytes were co-incubated with primary human endothelium in vitro. Compared to classical CD14+ monocytes or transwell cocultures, CD16+ monocytes enhanced endothelial STAT1 and NFκB p65 phosphorylation, upregulated expression of CX3CL1 and IL-1β, numerous CCL and CXCL chemokines and molecules promoting leukocyte patrolling and adhesion such as ICAM1 and VCAM1. Genes required for vasodilatation including eNOS decreased while endothelial collagen production increased. Uremic patients’ monocytes enhanced endothelial CX3CL1 even more markedly. Their receptor CX3CR1 was required for enhanced aortic endothelial stiffness in murine atherosclerosis with renal impairment. CX3CR1 dose-dependently modulated monocyte-contact-dependent gene expression in human endothelium. Conclusions By demonstrating endothelial proatherosclerotic gene regulation in direct contact with CD16+ monocytes, in part via cellular CX3CR1-CX3CL1 interaction, our data delineate a mechanism how this celltype can increase cardiovascular risk. Translational Perspective Human CD16+ monocytes strongly associate with cardiovascular disease. Our data show that they induce primary human arterial and venous endothelial chemokine and adhesion molecule expression and increase mediators of vascular stiffness in direct interaction of the endothelium with CX3CR1. CD16+ monocytes reversibly increase in human kidney failure. Our results propose CD16+ monocytes as mediators of cardiovascular events including the reversible vascular phenotype of patients with kidney failure. Interference with their direct contact to the endothelium may represent a causal therapeutic approach in this high-risk patient group.