The heart serves as the “energy factory” of the human body and is responsible for maintaining blood circulation and oxygen supplies. Its normal functioning thus relies on the generation of substantial amounts of ATP to support its mechanical activities. Under pathological conditions such as myocardial infarction, coronary artery sclerosis, and pulmonary hypertension, however, an insufficient blood supply leads to a reduced oxygen supply, subsequently activating a series of compensatory protective mechanisms. Hypoxia-inducible factor-1α (HIF-1α), as a nuclear transcription factor stably expressed under hypoxic conditions, has been shown to regulate oxygen transport by promoting angiogenesis and vasodilation, and to optimize oxygen utilization by regulating the balance of glucose and lipid metabolisms, thus participating in the regulation of various cardiac diseases. HIF-1α plays a crucial role in regulating cardiac energy metabolism and oxidative stress. This review systematically summarizes recent research regarding the various mechanisms of action of HIF-1α in reprogramming cardiac energy metabolism, explores its potential clinical applications in cardiovascular diseases, and proposes future research directions and possible treatment strategies. By comprehensively summarizing the mechanism of HIF-1α in ischemic heart disease, this article aims to provide new ideas and therapeutic targets for the prevention and treatment of cardiovascular diseases.