Extracellular vesicles (EVs) are heterogeneous cell-derived lipid-bilayer membranous nanoparticles serving as intercellular communicators by delivering their functional cargos (e.g., nucleic acids, proteins, lipids and metabolites) from donor cells to recipient cells [1]. Based on their biogenesis and size, EVs can be further divided into various subtypes, including exosomes, microvesicles (MVs), apoptotic bodies (ABs) and other vesicles [1], [2], [3]. Recently, cell-derived EVs (e.g., from cardiomyocytes, endothelial cells, smooth muscle cells, fibroblasts, immune cells and stem cells) were shown to participate in the regulation of pathophysiological processes of cardiovascular disease (CVD), the leading cause of mortality and disability despite recent advances in diagnostic and therapeutic techniques [4], [5], [6], [7]. In particular, EVs have been documented in the etiology of heart failure (HF), atherosclerosis (AS), myocardial infarction (MI), pulmonary arterial hypertension (PAH) and diabetic cardiomyopathy (DCM) [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. EVs found in body fluids (e.g., serum and urine) in subjects with CVDs exhibit a rather complex combination of molecules. The contents of EVs are closely associated with the pathological process of CVDs and can be protected and preserved by lipid-bilayer membranes of the vesicles [17]. EVs are easily detected in body fluids and their complex cargoes may differentiate CVDs more precisely as opposed to a single molecule. Thus, EVs are considered a promising biomarker for the diagnosis and prognosis of CVDs [17], [19].

The therapeutic potential of EVs to identify CVDs have been extensively evaluated in animal models given the advantages of EVs including accessibility, capacity of modification and storage, low immunogenicity and the ability to cross biological barriers in vivo [17], [19]. In this review, we will introduce the biology of EVs and specifically discuss the role of EVs in several CVDs. We will also summarize recent studies on EVs-related diagnostic/prognostic and therapeutic applications of CVDs.