Abstract: Ionizing radiation can induce atherosclerosis(AS). With increasing survival of patients after radiation therapy, the incidence of cardiovascular disease has increased significantly in the irradiated population. It is important to know the pathogenesis of ionizing radiation-induced AS. Amount of studies showed that the occurrence of AS is related to radiation-induced inflammatory, oxidative stress and genomic instability. Radiation induced bystander effect might also plays an effective role in AS induction. We hereby reviewed recent reports about radiation-induced AS and try to increase the knowledge of targeting therapy.