While the discovery of microRNAs has exponentially expanded our understanding of the regulatory mechanisms governing gene networks in many biological processes, the study of these tiny RNA powerhouses in cardiovascular disease is in its infancy. To date, there have been over 1200 human microRNAs identified, and they are estimated to affect the expression of over half of the protein-coding portion of the human genome. In this review, we will discuss miRNAs that are integral players in processes affecting risk factors for CVD, as well as miRNAs that act at the level of the vessel wall to affect atherogenesis. We will discuss how microRNAs are not only advancing the field of cardiovascular biology, but how some miRNAs are at the forefront of drug development and may be soon advancing into the clinic.