<p>Atherosclerosis (AS) is a chronic inflammatory disease characterized by the formation of fibrous fatty lesions or plaques within the arterial wall, which causes a large amount of morbidity and mortality worldwide. Copper is a mineral nutrient essential for the human body and is essential for maintaining the normal function of multiple human systems, including the cardiovascular system. Imbalance of copper homeostasis has been increasingly considered as a key factor affecting the pathogenesis and disease progression of AS. This article summarizes the complex association between copper ions and AS, focusing in particular on the key roles of copper metabolism, copper homeostasis and copper death. It aims to reveal the mechanism of action of copper ions in AS and explore treatment strategies targeting copper metabolism, copper death and copper homeostasis imbalance in relation to atherosclerosis, with a view to providing new perspectives and strategies for the treatment and prevention of AS.</p> Graphical Abstract <p></p>