Coronary artery disease (CAD) is the first leading cause of death worldwide. Therefore, novel therapeutic strategies need to be explored. Numerous publications reported that microRNA-654-5p (miR-654-5p) had anti-cancer activities in various cancers, and it was proven to modulate cell migration, invasion, and proliferation, which played critical roles in CAD. However, its role in CAD is unknown. Thus, we aimed to evaluate the role of miR-654-5p in vascular smooth muscle cells (VSMCs) involved in CAD. A total of 25 CAD patients and 19 healthy individuals were enrolled to evaluate their circulating miR-654-5p levels. miR-654-5p mimic or inhibitor were transfected into human VSMCs to assess their role on cell migration and proliferation. Target genes of miR-654-5p were predicted using TargetScan 7.2 and confirmed by the dual-luciferase reporter assay. miR-654-5p was significantly downregulated in the plasma of CAD patients and tumor necrosis factor-a/platelet-derived growth factor (PDGF)-BB-stimulated VSMCs. miR-654-5p mimic inhibited the proliferation and migration of VSMCs, which could be promoted by miR-654-5p inhibitor. A disintegrin and metalloproteinase with thrombospondin motifs-7 (ADAMTS-7) was identified as the direct target of miR-654-5p, whose expression could be induced by miR-654-5p inhibitor and decreased by its mimic. In addition, ADAMTS-7 overexpression blocked the inhibitory effect of miR-654-5p on the migration and proliferation of VSMCs. In summary, miR-654-5p inhibits the migration and proliferation of VSMCs by directly targeting ADAMTS-7, and miR-654-5p might serve as a novel therapeutic target for the treatment of CAD.