Cells communicate with other cells not only via direct cell–cell contact and the production of signaling molecules but also through release of microparticles (MPs). MPs are small vesicles released from stimulated and/or apoptotic cells. They harbor membrane proteins that are characteristic of the original parent cell and intracellular components involved in cell signaling. MPs are considered to be both biomarkers and effectors of cell signaling that maintain and/or initiate cell dysfunction. Thus, MPs can evoke endothelial dysfunction by decreasing nitric oxide (NO) production and promoting vascular inflammation which favor the prothrombotic state in atherosclerosis. Novel pharmacological approaches targeting MP production or properties could be used to treat cardiovascular pathologies. Paradoxically, another useful approach might be to employ engineered MPs with modified compositions as therapeutic agents to correct cardiovascular pathologies. This review is focused on the mechanisms of MP formation and their effects on target cells under physiological or pathophysiological conditions.