Atherosclerotic diseases have become the leading cause of human death. Apelin/APJ receptors is widely found in the cardiovascular system, and is involved in the occurrence and development of a variety of cardiovascular diseases. Studies on the effects of Apelin/APJ system on atherosclerosis suggested that Apelin has dual effects on atherosclerosis. On the one hand, Apelin can promote the proliferation and migration of vascular smooth muscle cells and endothelial cells, and induce mononuclear cell adhesion to endothelial cells, which could promote angiogenesis, and affect the stability of As plaques. On the other hand, Apelin can antagoninize AngⅡ to regulate intracellular lipid metabolism, and reduce the generation of endothelial reactive oxygen species and cellular aging, prevent macrophages from turning into foam cells, and have a certain stabilizing effect on the As plaque that has been formed. In addition, it can also inhibit platelet activation, ultimately reducing the occurrence of atherosclerosis complications. Meanwhile, as a double-edged sword with protection or damage, autophagy may be one of the important targets of Apelin in atherosclerosis. This paper summarizes the research on Apelin/APJ system and atherosclerosis in the above aspects, and explores the possibility of Apelin/APJ receptor as a target for preventing or treating atherosclerosis.