Macrophages are heterogeneous and plastic, and the microenvironment is a key factor affecting the phenotypic changes of macrophages. In cardiovascular disease, macrophages can polarize into different phenotypes (M1, M2,et al) depending on their microenvironment. They express different surface receptors, release different cytokines, are regulated by a variety of signaling pathways and transcriptions, and perform different functions in the development of cardiovascular diseases. M1 is responsible for initiating and maintaining inflammatory responses by secreting pro-inflammatory factors; M2 is involved in inflammation resolution and tissue repair by secreting anti-inflammatory factors. Traditional Chinese medicines have the functions of strengthening the body, promoting blood circulation and removing blood stasis, clearing heat and detoxifying. By regulating JAK/STAT, PI3K/Akt, Toll receptors and other signaling pathways, it reduces the aggregation of macrophages, promotes the polarization of macrophages to M2 or restores M1/M2 homeostasis to improve the inflammatory microenvironment and delay disease progression. This paper mainly systematically sorts out the origin of macrophages, the polarization and regulation mechanism of macrophages, the role of macrophage polarization in cardiovascular diseases and the intervention of traditional Chinese medicine, and provides theoretical guidance for clinical prevention and treatment of cardiovascular diseases.