Cardiovascular disease seriously threatens human health and is still the main cause of human death. The exosomes released by mesenchymal stem cells (MSC) act on the heart and blood vessels, which can exert anti-apoptosis, anti-inflammatory, anti-fibrosis, and accelerate the generation of endothelial cell and angiogenesis. The role is the key mechanism of MSC transplantation therapy. This article summarizes relevant domestic and foreign researches in the past five years, reviews the mechanism of MSC-derived exosomes in the treatment of cardiovascular diseases, and discusses exosomes as a new approach for the treatment of cardiovascular diseases in the future.