Artery stenosis due to atherosclerosis is the most common cause of cardiovascular disease. In addition to known risk factors, researchers have found that intestinal flora can influence the pathogenesis of atherosclerosis through its metabolites (short-chain fatty acids, trimethylamine oxide, indoles), the metabolism of bile acids, and the inflammatory response, and the relevant evidence has been supported experimentally. This article presents a systematic review of the relationship between intestinal flora and atherosclerotic cardiovascular disease, the microscopic mechanisms by which intestinal flora affect the pathogenesis of atherosclerotic cardiovascular disease, and recent advances in the treatment of atherosclerotic cardiovascular disease using intestinal flora as a target.