<p>Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Therefore, an in-depth understanding of its pathogenesis is essential for the development of effective treatment options. Altered cellular metabolism has been identified as a common pathological mechanism underlying different types of vascular diseases, providing a key research direction. Polyamines, as derivatives of arginine, are polycations that are widely distributed in plants and animals and are essential for the growth and development of mammalian cells. Disorders of polyamine metabolism are closely associated with the development of several vascular diseases. Polyamine metabolism intervention and reprogramming are emerging as potential therapeutic tools for many diseases. In this review, we summarize the role of polyamine metabolism in vascular diseases, focusing on the synthesis and catabolism of polyamines, the connections between other metabolic processes and polyamines, and their roles in the development of various vascular diseases. This study also summarizes the latest research on polyamines in vascular diseases and aims to provide new perspectives for the treatment of these disorders.</p>