Vascular endothelial cells, macrophages, and smooth muscle cells (SMC) participate in atherogenesis.Recent studies show that as many as 70% of all cells in atherosclerotic lesions are smooth muscle cells-derived. Inflammatory cytokines and immune modulators secreted by smooth muscle cells in the atherosclerotic plaque promote smooth muscle cell proliferation, migration and inflammatory response, and activate and recruit macrophages to the atherosclerotic lesions in a autocrine or paracrine manner. Moreover, smooth muscle cells in atherosclerotic lesions express receptors for lipid and can take up modified lipoproteins, leading to a massive accumulation of cholesterol esters and the formation of foam cells in the atherosclerotic plaque. Thus, smooth muscle cells play a key role in the formation of atherosclerotic plaque, the role and mechanism of action of smooth muscle cells in the atherosclerotic plaque pathogenesis need to be further studied.