Atherosclerosis is the main cause of most cardiovascular diseases, but its pathogenesis is complicated and has not been fully understood. More and more studies have shown that the disorder of lipid metabolism may play an important role in the initiation and development of atherosclerosis. As a group of bioactive lipids participating in cell structure component and signal transduction, sphingolipids have been proved to be abnormal in blood and vascular lesion in patients with cardiovascular diseases. Some sphingolipids may be potential biomarkers and therapeutic targets in cardiovascular diseases. This review is focused on the influences and regulatory mechanisms of sphingolipids on the initiation and development of atherosclerosis trying to find new ideas and molecular targets for the prevention and treatment of atherosclerosis.