All-trans retinoic acid (ATRA), a potent natural, active metabolite of vitamin A, has a critical role in numerous biological processes, including lipid metabolism, adipocyte differentiation, and the immunological system. Increasing evidence from cellular and animal studies highlights its importance in cardiovascular diseases (CVD), acting through anti-atherogenic activity by inhibitory effects on thrombosis and inflammatory responses, modulating nitric oxide pathways, and inhibiting the proliferation and migration of arterial smooth muscle cells. ATRA mitigates endothelial dysfunction and reduces atherogenic plaque formation. It modulates oxidative stress, promotes endothelial repair, and limits cardiomyocyte hypertrophy, fibrosis, and apoptosis. The cardioprotective function of ATRA is also correlated with atrial natriuretic peptide activation. ATRA decreases the risk of obesity, improves insulin sensitivity, and reduces inflammation, the significant contributors to cardiovascular disease and metabolic disorders. This paper reviews ATRA's mechanisms in CVD pathology and its broader role as a cardioprotective agent, emphasizing its impact on inflammation, lipid metabolism, myocardial remodeling, and adipose tissue.