Since the discovery of exosomes, cardiovascular disease therapeutic research has gained interest. Proteins, cytokines, and miRNAs are among the active chemicals present in stem cell-generated exosomes. Exosomes from stem cells include anticardiomyocyte apoptosis, anticardiomyocyte damage, angiogenesis-promoting miRNAs and growth factors. Exosomes can also be used to prevent heart attacks, hypertension, heart failure, and cardiomyopathy. Using exosomes gives several advantages over stem cell transplantation. Exosome therapy is less stressful, reducing the possibility of abnormal differentiation (e.g., stem cells differentiating into bone, fat, or even tumors). Exosomes cause no obvious negative effects, including fever, allergy, or hemolysis. Exosome therapy has no ethical problems. Exosomes have several advantages, but they also have some downsides when employed. Exosomes are produced throughout the body by a number of cells, and the specific function of exosomes from various sources is challenging to identify. Exosome extraction is challenging, and few exosomes are accessible. This results in an unmet need for a standardized and effective extraction procedure. Exosome content is unstable, susceptible to fluctuations. Although stem cell-derived exosomes have several limitations, they have shown promise in cell-free applications in regenerative medicine. Exosomes, a critical component of the paracrine influence of stem cells, may transfer certain miRNAs, mRNAs, and proteins to target cells, increasing cell proliferation, differentiation, survival, and angiogenesis while blocking apoptosis and inflammation. As a result, cell-free exosomes seem to be a promising CVD therapeutic approach.