Atherosclerosis (As) is associated with iron metabolism. It is still controversial whether the iron gathered in plaque is a pathogenic factor or a simple consequence caused by hemolysis in the development of As disease. Macrophages play a key role in the formation and development of As plaques. This review summarizes the research progress of macrophage iron metabolism and As. This paper first introduces the Hepcidin-Fpn1 axis that plays an important role in macrophage iron metabolism, and then introduces the effect of macrophage iron metabolism on the development of As from 3 aspects of inflammation, infection and hemorrhage in plaque. Finally, the new ideas of As therapy related to iron metabolism are introduced.