Previously, it was believed that vascular endothelial cells were regarded merely as a structural component of the cardiovascular wall. However, in recent years, it has been discovered that endothelial cells have multiple guiding functions. Endothelial cells convert mechanical stimuli into biochemical signals through receptor tyrosine kinases, ion channels, integrins, and junction proteins. The vascular endothelium also participates in the control of organ metabolism by regulating insulin, lipids, glucose and other substances. Capillary endothelial cells not only transport oxygen or nutrients, but also provide support for organ development and adult organ regeneration through paracrine action. In addition, vascular endothelial cells can also maintain metabolic homeostasis in an endocrine manner. This article reviewed the mechanism of endothelial guidance function in vascular endothelial cells, in order to provide new strategies for the treatment of related diseases.