Atherosclerosis is a lipid-driven chronic inflammatory disease that typically forms plaques in large and medium-sized arteries and is a major cause of ischemic heart disease and stroke. Recent studies have found that during the progression of atherosclerosis, the level of cellular glycolysis in plaques increases, leading to excessive production and excretion of lactate and acidification of the extracellular environment, which may further affect the development of atherosclerosis through multiple mechanisms. This article reviews the research progress on the role of lactate metabolism in atherosclerosis, which may provide new therapeutic targets and directions for the prevention and treatment of atherosclerosis.