Atherosclerosis (AS) is associated with high morbidity and mortality rates and currently has no effective treatment. This study was aimed at investigating the role of macrophage exosomes in the inflammation and apoptosis after HUVEC injury. We established the HUVEC injury model using 100 mg/L oxidized low-density lipoprotein (ox-LDL) or 50 ng/mL tumor necrosis factor-α (TNF-α). Cell proliferation was assessed using cell counting kit-8 (CCK8) assays, and the expression of miR-221, TNF-α, and IL-6, IL-10, and IL-1β was detected using quantitative real-time PCR (qRT-PCR). The apoptotic rate was analyzed by the TUNEL method, and the expressions of apoptosis-related proteins Bcl2, Caspase-3, and c-myc were detected by western blotting. Finally, miR-221-3p mimics and miR-221-3p inhibitors were constructed by liposome transfection to determine the mechanism of action of macrophage exosomes on HUVEC injury. The expression levels of IL-6, IL-1β, and TNF-α in the injury groups were higher than those in the normal group, but the expression of IL-10 in the injury groups was lower than that in the normal group. Meanwhile, the apoptotic rate of the HUVEC cell injury group was higher than that of the normal group. In contrast, the expression levels of IL-6, IL-1β, and TNF-α were lower in the M2 macrophage exosome (M2-Exo) group, but the expression of IL-10 was higher compared with the control group. The apoptosis rate was reduced in the M2-Exo group, and the expression of the proapoptotic gene Caspase-3 was reduced, while the expression of the antiapoptotic gene Bcl2 was increased. Liposome transfection of miR-221-3p mimics was able to enhance the effect of M2 macrophage exosomes. Thus, M2-Exo promotes HUVEC cell proliferation and inhibits HUVEC cell inflammation and apoptosis. miR-221-3p overexpression attenuates HUVEC cell injury-induced inflammatory response and apoptosis, while miR-221-3p gene inhibition enhances this inflammatory response and apoptosis.