Shift work, particularly night shifts and rotating schedules, has become a common working pattern worldwide. However, epidemiological studies indicate that shift work significantly increases the risk of cardiovascular diseases, especially atherosclerosis. By disrupting circadian rhythms, impairing sleep quality, inducing metabolic abnormalities, exacerbating inflammatory responses, causing dyslipidemia, and promoting oxidative stress, shift work facilitates the onset and progression of atherosclerosis (AS). Despite ongoing advances in mechanistic research, the prevention and intervention for AS among shift workers remain inadequate, and health management for this population urgently needs to be strengthened. Therefore, this review synthesizes the current literature to elucidate the mechanisms through which shift work influences AS and to propose effective intervention strategies, with the aim of providing a theoretical basis and practical guidance for cardiovascular health management in shift-working populations.