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Atherosclerosis is a chronic inflammatory disease in which atheromatous plaque long-termly accumulates and obstructs the intima of medium and large arteries, causing first severe stenosis and blood flow disorders, and then ischemia and hypoxia in tissues and organs. Nanomedicines have received widespread attention for their unique advantages over conventional drugs in the treatment of atherosclerosis. This article detailedly reviews several nanoparticle- and exosome-based targeted drug delivery systems in anti-atherosclerosis research, briefly describes the synthesis of representative nanomaterials, analyses their targeting properties and outlines the benefits and inherent challenges of nanomedicines. Despite the challenges that need to be addressed and refined, nanoparticles and exosomes used as drug delivery vehiclesin treatments for atherosclerosis hold great promise and are expected to have wider clinical applications.