Epigenetic regulation refers to hereditary changes in gene expression but the DNA sequence remains unchanged. At present, the main mechanisms known for epigenetic regulation include DNA methylation, histone modification and non-coding RNA. Many studies have confirmed that epigenetic regulation is essential in cardiovascular diseases, tumors and autoimmune diseases. In recent years, more and more evidence has shown that epigenetic regulation plays an important role in the pathogenesis of atherosclerosis. This article focuses on the regulation of vascular smooth muscle cells by three major types of epigenetic regulation, DNA methylation, histone modification and non-coding RNA, to explore the important role of the regulation in the development of atherosclerosis.