Exosomes are nano-level matrix vesicles from cellular endocrine to extracellular level. They have a bilayer structure of phospholipids and contain a variety of cell-specific lipids, nucleic acids and proteins. They are mainly involved in the processes of cellular communication, immune regulation and cellular signal pathway regulation. In recent years, studies have found that exosomes play an important role in the occurrence and development of vascular smooth muscle cells in vascular calcification. Understanding the mechanism by which exosomes regulate vascular smooth muscle cell calcification plays an important role in preventing vascular calcification and reducing the risk of cardiovascular disease in the future.