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Background: Cardiovascular disease (CVD), including myocardial ischemia, remains the leading cause of mortality. Current therapies for ischemic myocardium rely largely on invasive revascularization strategies, highlighting the need for improved non-invasive diagnostic and therapeutic approaches. Recent studies suggest that extracellular vesicles (EVs) play a critical role in cardiovascular pathophysiology and may offer novel clinical applications. Methods: This review synthesizes current preclinical and clinical literature on EV biology, including their classification, isolation, and characterization methods, and mechanisms of Intercellular communication. Published studies evaluating EVs as biomarkers and non-surgical therapeutics across major cardiovascular conditions were critically analyzed. Results: EVs facilitate intercellular communication by transferring bioactive molecules that influence disease progression and cardiac repair. Accumulating evidence supports their potential utility as biomarkers for disease prediction and severity assessment, as well as cell-free therapeutics in myocardial infarction, cardiomyopathies, atrial fibrillation, and heart failure. However, significant gaps remain, including the lack of validated EV-based biomarkers, inconsistent isolation and characterization methodologies, limited in vivo tracking data, and barriers to clinical translation. Conclusions: EVs represent a promising frontier in non-invasive cardiovascular diagnostics and therapeutics. Addressing current methodological and translational challenges, alongside advances in EV bioengineering, will be essential to realize their full clinical potential in CVD management.