Metabolites produced by the gut microbiota play various physiological regulatory roles through interactions with the host and are closely related to human health. Imidazole propionate, a metabolite derived from histidine by the gut microbiota, has garnered significant attention in recent years due to its close association with chronic diseases such as type 2 diabetes and cardiovascular diseases. This article reviews the metabolic pathways of imidazole propionate, its correlation with metabolic and cardiovascular diseases, its mechanisms of action, and current methods for its detection and associated interventions. The aim is to provide a reference for the prevention and control of chronic diseases targeting imidazole propionate.