Recently, a novel endogenous ligand of APJ called elabela has been identified to play an important role in cardiovascular development. Elabela and its G-protein-coupled receptor APJ are widely expressed throughout the human body. These have been identified to play a significant role in diverse biological processes, especially in the normal and pathological cardiovascular systems. In addition, increasing evidence indicates that elabela is also intimately associated with a large number of vascular physiological processes in adulthood, such as angiogenesis, vascular tone and atherosclerosis. However, a comprehensive summary of elabela in the vascular system has not been reported to date. In this review, we provide an overview of elabela in vascular physiology and diseases. Collectively, elabela, a potential biomarker and therapeutic peptide, exerts diverse biological vascular effects in adults.