The gut microbiome actively regulates host immunity, digestive processes, and the function of the intestinal endocrine system. Additionally, it modulates host neural signal transmission and nutrient metabolism through metabolite generation. Vascular calcification involves the deposition of calcium phosphate in blood vessel walls, secondary to metabolic disorders such as chronic kidney disease, atherosclerosis, diabetes, and osteoporosis. Recent research spanning the past two decades has indicated a close correlation between shifts in the composition and functionality of the gut microbiota, along with its metabolites, and the onset of metabolic disease-related vascular calcification. This paper presents a comprehensive review of the roles and mechanisms of the gut microbiota in this context.