Metabolic reprogramming plays a crucial role in the pathogenesis of cardiovascular diseases (CVD). Lactate, a metabolite of glycolysis, is now considered an important cellular signaling molecule involved in regulating various metabolic processes within the microenvironment. Recently discovered lactylation modifications have been found to play significant roles in CVD such as atherosclerosis (As), vascular or valve calcification, myocardial infarction, heart failure (HF), and pulmonary hypertension (PH). This review summarizes the regulatory mechanisms of lactate and lactylation modifications in these CVD, aiming to provide new insights for their precise prevention and treatment strategies.