Atherosclerosis results from the excessive accumulation of lipids within the arterial wall. Lipophagy, referred to as the autophagic degradation of lipids, is a critical mechanism that regulates lipid metabolism in numerous cell types. The contribution of lipophagy to intracellular lipid turnover makes it a major player in the development and progression of atherosclerosis. This review addresses recent advances in lipid metabolism via lipophagy. The relationship between lipophagy and atherosclerosis is discussed focusing on the roles of lipophagy in vascular endothelial cell injury, vascular smooth muscle cells phenoypic shift, and macrophage lipid accumulation. A further understanding of lipophagy in these processes may provide promising new therapeutic options for atherosclerotic diseases.