Atherosclerosis (AS) is a common cardiovascular disease that can cause serious complications and is one of the most common causes of patient death. The inflammatory response is involved in the pathogenesis of atherosclerosis and leukotrienes (LTs) are important inflammatory mediators that play immunomodulatory and proinflammatory roles in the inflammatory signaling pathway. Leukotrienes are closely related to atherosclerosis. Leukotriene B4 ( LTB4), cysteinyl leukotrienes, and the 5-lipoxygenase (5-LOX) pathway trigger a plaque formation disorder that promotes AS by inducing neutrophil aggregation, enhancing endothelial cell permeability, and mediating nuclear calcium signal transduction in vascular smooth muscle. Additionally, obstructive sleep apnea (OSA) and diabetes that produce LTs are associated with AS. Intermittent hypoxia in patients with OSA increases production of LTB4 and expression of 5-lipoxygenase. Increased matrix metalloproteases in diabetic patients promote expression of 5-LOX and LTB4. This article discussed the current research on the roles of LTs and related substances in the metabolic pathway in the pathogenesis of atherosclerosis and its treatment. Thus, some new treatment strategies aimed at LTs for anti-AS effects have been proposed, which include inhibition of LT receptors, the 5-LOX pathway and LTA4 hydrolytic enzyme.