Atherosclerosis(As) is the main pathological basis of ischemic cardiovascular and cerebrovascular diseases such as coronary heart disease and cerebral infarction. Its etiology is complicated and the pathogenesis has not been fully clarified. In recent years, more and more studies revealed that sphingomyelin signaling pathway can affect the occurrence and development of atherosclerosis by regulating lipid metabolism, inflammation and vascular endothelial function. This paper reviews the relationship between sphingomyelin, ceramide and sphingosine-1-phosphate, the key molecules of sphingomyelin signaling pathway, and atherosclerosis in order to provide new ideas for the prevention and treatment of As.