Atherosclerosis is a lipid-driven chronic inflammatory disease characterized by the accumulation of apolipoprotein B-rich lipoproteins, immune cells, and extracellular matrix under the arterial endothelium to form atherosclerotic plaques. The modified lipoproteins acquire damage-related molecular patterning characteristics, first triggering an innate immune response dominated by monocytes-macrophages, followed by an adaptive immune response. These inflammatory responses are often chronic and irreversible, and can lead to arterial damage and thrombus-induced organ infarction. This article mainly reviews the role of the immune system in the occurrence and development of atherosclerosis and the current main immune prevention strategies for atherosclerosis.