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This article discusses the role of ceramides, a class of sphingolipids, in atherosclerotic cardiovascular disease (ASCVD). Ceramides are bioactive molecules involved in various cellular processes, including inflammation, apoptosis, and insulin resistance. Recent advances in plasma lipidomics have identified circulating ceramides as risk predictors for ASCVD. Ceramide-based risk scores, such as the Coronary Event Risk Test (CERT) 1 and CERT2, have been developed and validated for primary and secondary ASCVD risk stratification. Lowering ceramide levels through various therapeutic strategies shows promise in improving ASCVD outcomes. Further research is needed to understand the mechanisms by which ceramides contribute to atherosclerosis and to determine the potential benefits of ceramide-lowering interventions. [Extracted from the article]