<p>Atherosclerosis is a chronic disease that is characterized by lipid accumulation and inflammation in the arterial wall. Atherosclerotic plaques form beneath the intima of large and medium-sized arteries and this is a leading cause of ischemic heart disease and stroke. Recently, with the intensification of global aging trends, the prevalence of atherosclerosis has increased significantly. Lactate, which is a byproduct of glycolysis, plays crucial roles in cell signaling, inflammatory responses, and metabolic regulation. Research on lactate and lactylation modifications in atherosclerotic cardiovascular diseases has gradually gained attention. This article reviews the latest research progress on lactate and its modifications in atherosclerotic cardiovascular diseases; explores mechanisms in pathological processes such as inflammation, oxidative stress, and apoptosis; and analyzes the potential as biomarkers and therapeutic targets. This review provides a reference for further studies on the role of lactate and lactylation in atherosclerotic cardiovascular diseases.</p>