Cardiovascular disease (CVD) is a top public health problem especially for the elderly. Atherosclerosis is the pathological basis of CVD. Many studies have shown that epigenetics plays a key role in regulating the development of atherosclerotic disease. Epigenetics includes DNA methylation, histone modification, RNA methylation, and non-coding RNA. More and more epigenetic regulations are confirmed to take part in heart development, response to stress, and endothelial injury, it is even suggested that atherosclerosis is the result of abnormal epigenetic regulation. Researchers have performed studies on novel drugs through epigenetic modification, yielding varied results. It is necessary to explore a range of epigenetic mechanisms to explain the causes and progression of atherosclerosis and uncover new targets for treatment. This article summarizes the latest development of epigenetic modification and its effect on the occurrence and progression of atherosclerosis and the possible prevention and treatment modalities of atherosclerosis that these research findings would engender.