This review synthesizes existing evidence to clarify its context-dependent dual roles across various cardiovascular diseases: on the one hand, ADAMTS1 exerts protective functions by maintaining vascular integrity and mitigating inflammatory responses; on the other hand, in conditions such as myocardial infarction and aortic aneurysms, ADAMTS1 promotes pathological progression by excessively hydrolyzing the multifunctional proteoglycan versican and other substrates, leading to tissue disruption and adverse remodeling. The gene discussed is ADAMTS1; the disease is myocardial infarction.