Vascular smooth muscle cell (VSMC) phenotypic modulation and proliferation are critical cellular events in the development of a variety of proliferative vascular diseases. However, the molecular mechanisms involved in these cellular events are still unclear. MicroRNAs (miRNAs) represent a novel class of small, non-coding RNAs that negatively regulate gene expression via degradation or translational inhibition of their target mRNAs. In a previous study, we identified that miR-145 is the most abundant miRNA in normal arteries and VSMCs. However, the roles of miR-145 in VSMC biology and vascular disease are unknown. In our recent Circulation Research article, we found that the expression of miR-145 is significantly downregulated in dedifferentiated VSMCs and in balloon-injured arteries. Moreover, both in vitro and in vivo studies demonstrated that miR-145 is a critical modulator of VSMC phenotype and proliferation. This review article summarizes the current research progress regarding the roles of miR-145 in VSMC biology and discusses the potential therapeutic opportunities surrounding this miRNA in vascular disease.