Innate immune response plays important roles in the lesion initiation and progression of atherosclerosis (As). Innate immune cells, including monocyte/macrophages, mast cells, natural killer cells, neutrophilic granulocytes and dendritic cells, represent the first line of defense against pathogens and foreign agents. These cells have extensive effects involved in foam cell formation, extracellular matrix degradation, cell apoptosis, angiogenesis and As plaque rupture. Pattern recognition receptors, including Toll-like and NOD-like receptors, could mediate innate immune response by recognize pathogen-associated molecular patterns or some endogenous components. TLRs are differentially expressed by the various cell types in atherosclerosis, and have different roles. TLR2 and TLR4 accelerate the progress of atherosclerosis, but the TLR3 induces protection of the atherosclerosis development. NLRP3 inflammasome is related to early arterial wall damages. Further researchs on the roles of the innate immune cells and pattern recognition receptors in atherogenesis help to understanding the formation of atherosclerosis, and also provide novel potential therapeutic and diagnostic targets in the future treatment of cardiovascular disease.