Atherosclerosis, a global health concern, has attracted researchers worldwide due to its severe consequences. The elderly are particularly susceptible to cardiovascular diseases and events, making them a high-risk group. Although gaps in our understanding of atherosclerosis pathogenesis persist, it is evident that oxidative stress, endothelial dysfunction, inflammation, mitochondrial dysfunction, and autophagy impairments are key components of its development. Remarkably, these features are also observed in the aging process, suggesting that atherosclerosis may be an aging-associated disease. However, causality relationships between aging, atherosclerosis, and associated mechanisms continue to be speculative. Additionally, the lack of effective therapeutic options for both atherosclerosis and aging poses a significant challenge. Sirtuins hold promise as potential agents in addressing this challenge. This review aims to consolidate evidence on the association between atherosclerosis and vascular aging through mitochondrial dysfunction and discusses the potential role of sirtuins as therapeutic options for atherosclerosis.