Cardiovascular disease is the leading cause of death. Moreover, the incidence of cardiovascular disease in young/middle-aged people (18~45 years old) is still on the rise. Early diagnosis, early warning and treatment of cardiovascular disease are important topics in the current medical research field. Atherosclerosis is the pathophysiological basis of many cardiovascular diseases. Recent studies have shown that the tricarboxylic acid (TCA) cycle intermediate is involved in the occurrence and development of atherosclerosis, and considered as the early diagnosis and warning bio-markers for atherosclerosis. Here, the roles and underlying mechanisms of succinate in the initiation and progression in atherosclerosis were reviewed.