<p>Cardiovascular diseases (CVDs) remain the global leading cause of mortality, necessitating novel diagnostics and therapies. Extracellular vesicles (EVs)—including exosomes, microvesicles, and apoptotic bodies—serve as key intercellular communicators in cardiovascular system. As carriers of bioactive miRNAs/proteins, EVs regulate inflammation, fibrogenesis, angiogenesis, and cardiac/systemic communication. Their non-invasive accessibility and disease-specific molecular signatures enable diagnostic applications. Endogenous origin and targeting capacity make EV ideal drug delivery platforms, while engineering of surface/content properties enhances their therapeutic specificity. However, key challenges persist in reproducibility, long-term safety profiles, clearance mechanisms, and therapeutic applications. Therefore, we highlight the potential of EVs as engineered drug carriers and their therapeutic promise for CVDs such as myocardial infarction, atherosclerosis, and heart failure. Future clinical translation of EV-based tools offers transformative potential—from cardiovascular diagnostics to regenerative therapies—where collaborative efforts will accelerate the pipeline development of these emerging solutions for clinical CVDs management.</p> Graphical Abstracts <p>Extracellular vesicles (EVs), including exosomes, microvesicles, and apoptotic bodies, have emerged as key players in disease progression, diagnostic biomarkers, and therapeutic tools in the field of CVDs. This review summarizes key aspects of EVs—including structure, biogenesis, and functions—along with current technological limitations and future clinical potential in CVDs.</p> <p></p>