Atherosclerosis (AS), the main pathophysiological basis leading to cardiovascular disease, is now considered to be a chronic inflammatory condition. There is experimental and clinical evidence that adaptive immune mechanisms can accelerate or curb AS. The adaptive immune cells includes T cells and B cells that secreting different cytokines or antibodies, possess pro-inflammatory or anti-inflammatory properties. The role of some T and B cell subtypes in AS is still debated. Th17 and Treg cells may suggest for plasticity of T cell that can switch the phenotype dependening on the local microenvironment. In addition, there are complex interplay between lipid metabolism and adaptive immune system. The recent Canakinumab Antiinflammatory Thrombosis Outcomes Study (CANTOS) provided pivotal support on anti-inflammatory strategies to treat AS, and immune regulation or vaccination against immune system is also a promising approach for treating AS. This article reviews the advances of adaptive immune mechanisms in AS in recent years as well as discuss their future perspective as potential diagnosis and prevention of cardiovascular diseases targets.