Cardiovascular diseases are the most common causes of human morbidity and mortality despite significant therapeutic improvements by surgical or pharmacological approaches in the last decade. MicroRNAs (miRNAs) have a significant role in diseases development or response to treatment. In this review, we summarized the role of miRNAs in the pathogenesis or the treatment of coronary artery disease (CAD). We searched four electronic databases (PubMed, Ensemble, Science Direct and Ensemble) with no date limit. All of the selected articles investigated microRNAs activity and/or therapeutic approaches related to CAD.  The exclusion criteria were a sample size <100 patients, editorials, and other diseases and comorbidities. With these criteria, we identified 52 prospective studies published in the last decade with a total of around 20,000 participants. Most of the studies support the concept that alterations in miRNAs activity levels might be associated with the risk of CAD development. Here, the current knowledge about the miRNAs biology, and the clinical advantage of miRNAs modulation as therapeutics in cardiovascular system are reviewed and discussed.