The process of atherosclerotic lesions is a proliferative response induced by arterial intimal injury, which occurs in the bifurcation and branching regions of the arteries with low shear stress (LSS). LSS regulates gene expression and phenotype transformation by activating membrane receptors and intracellular signal transduction on cells, and plays an important role in the occurrence and development of atherosclerosis. This article reviews the relationship between LSS and endothelial cell inflammation, endothelial-to-mesenchymal transition, endothelial cell autophagy and its regulatory mechanism, hoping to provide new ideas and strategies for the prevention and treatment of atherosclerosis.