Extracellular Vesicles in Atherosclerosis: From Pathogenesis to Theranostic Applications

Abstract Atherosclerosis is a chronic vascular inflammatory disorder, and the cardiovascular disease resulting from it is the leading cause of death worldwide. Extracellular vesicles (EVs) are small membrane vesicles secreted by cells, playing a crucial role in regulating intercellular communication, signal transduction, and various pathophysiological processes. EVs have been shown to play a significant role in the progression and regression of atherosclerotic cardiovascular disease. Therefore, a comprehensive understanding of the role of EVs in the pathogenesis of atherosclerosis is essential for advancing knowledge in this field and driving the development of innovation of novel diagnostic and therapeutic strategies. This review summarizes the pathological roles of EVs in atherosclerosis, including their involvement in endothelial cell inflammation, the phenotypic transformation of vascular smooth muscle cells, macrophage activation, foam cell formation, and plaque thrombosis and rupture. Furthermore, it discusses innovative EV‐based strategies for diagnosing and treating atherosclerosis. Finally, the challenges and prospects of translational research on EVs in atherosclerosis are discussed. This work aims to provide an EV‐centered perspective on the diagnosis and treatment of atherosclerosis.