Atherosclerosis is a complex pathological process that is based on the chronic inflammatory reaction of the blood vessel wall and involves various immune cells and cytokines. The imbalance in the proportion and function of effector CD4 ⁺ T cell (Teff) and regulatory T cell (Treg) subsets is an important cause of the occurrence and development of atherosclerotic plaques. Teff cells depend on glycolytic metabolism and glutamine catabolic metabolism, while Treg cells mainly rely on fatty acid oxidation (FAO) for energy, which is crucial for determining the fate of CD4 ⁺ T cell differentiation and maintaining their respective immune functions. Here, we review recent research achievements in the field of immunometabolism related to CD4 ⁺ T cell, focusing on the cellular metabolic pathways and metabolic reprogramming involved in the activation, proliferation and differentiation of CD4 ⁺ T cell. Subsequently, we discuss the important roles of mTOR and AMPK signaling in regulating the fate of CD4 ⁺ T cell differentiation. Finally, we evaluate the links between CD4 ⁺ T cell metabolism and atherosclerosis, highlighting the potential of targeted modulation of CD4 ⁺ T cell metabolism in the prevention and treatment of atherosclerosis in the future.