REVIEW MicroRNAs as the actors in the atherosclerosis scenario Fatemeh Hajibabaie 1,2 & Shirin Kouhpayeh 3 & Mina Mirian 4 & Ilnaz Rahimmanesh 5 & Maryam Boshtam 6 & Ladan Sadeghian 6 & Azam Gheibi 7 & Hossein Khanahmad 5 & Laleh Shariati 6,8 Received: 1 May 2019 /Accepted: 21 October 2019 # University of Navarra 2019 Abstract Atherosclerosis is considered as the most common cardiovascular disease and a leading cause of global mortality, which develops through consecutive steps. Various cellular and molecular biomarkers such as microRNAs are identified to be involved in atherosclerosis progression. MicroRNAs are a group of endogenous, short, non-coding RNAs, which are able to bind to specific sequences on target messenger RNAs and thereby modulate gene expression post-transcriptionally. MicroRNAs are key players in wide range of biological processes; thus, their expression level is regulated in pathophysiological conditions. Ample evidences including in vitro and in vivo studies approved a critical role of microRNAs in epigenetic and the sequential processes of atherosclerosis from risk factors to plaque formation, progression, and rupture. Based on these findings, miRNAs seems to be promising candidates for therapeutic approach. This review summarizes the role of miRNAs in atherosclerosis development, epigenetic, and therapy. Moreover, the application of exosomes in miRNA delivery, and/or their prognostic and diagnostic values are also discussed. Keywords Atherosclerosis . Endothelial cells . Inflammation . MicroRNA Introduction Atherosclerosis as the most prevalent cardiovascular disease is considered the leading cause of mortality worldwide. The athero- sclerosis phenomenon is categorized into three stages of inditiation, plaque progression, and disruption. The endothelium injury which occurs following a number of risk factors including hypertension, smoking, or lipid metabolic disorders, initiates a cascade of processes such as cellular infiltration, intra-plaque angiogenesis, hemorrhage, and matrix degradation. Endothelial Fatemeh Hajibabaie and Shirin Kouhpayeh contributed equally to this work. Key points This article review: The supporting evidences of miRNAs to atherosclerosis process The role of miRNAs in clinical relevance of atherosclerosis The application of miRNAs in diagnosis The application of miRNAs as therapeutic agents. * Laleh Shariati shariati_l@razi.tums.ac.ir 1 Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran 2 Applied Physiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 3 Department of Immunology, Erythron Genetics and Pathobiology Laboratory, Isfahan, Iran 4 Isfahan Pharmaceutical Science Research Center, School of Pharmacy and Pharmaceutical Science, Isfahan University of Medical Sciences, Isfahan, Iran 5 Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 6 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran 7 Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran 8 Department of Biomaterials, Nanotechnology and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal of Physiology and Biochemistry https://doi.org/10.1007/s13105-019-00710-7