Atherosclerosis (AS) is a chronic inflammatory metabolic disease closely associated with risk factors such as hypertension, hyperlipidemia, hyperglycemia, and hyperuricemia. The intestinal barrier function plays an important regulatory role in maintaining intestinal homeostasis, and intestinal flora is an important component. Disturbance of intestinal flora can lead to intestinal barrier damage and an increase of intestinal permeability. The related products, such as lipopolysaccharide, short chain fatty acids, bile acids, and trimethylamine oxide change and can cause inflammation, oxidative stress, and other adverse reactions that then affect the occurrence and development of AS. In this article, we review the interaction between intestinal flora and the intestinal barrier in AS development and its risk factors, and provide a reference for the study and prevention of AS.