High plasma concentrations of free fatty acids (FFA) and insulin are common features in atherosclerotic patients with type 2 diabetes. FFA, according to their nature, can have various effects on vascular smooth muscle cells (VSMC). These cells play important roles throughout atherosclerosis pathogenesis, from plaque development to plaque instability. Thus, this study aims to assess the impact of two FFA combinations and insulin on murine VSMC viability. The two combinations contain the same FFA but at different ratios, one being richer in saturated fatty acids (SFA) and the other having a higher proportion of monounsaturated fatty acids (MUFA). Both combinations inhibited VSMC proliferation due to their pro-apoptotic potential, with SFA being the major inducers of apoptosis. However, the presence of oleic acid (OLA) attenuated this impact in a dose-dependent manner. OLA had also the capacity to reduce apoptosis rates more strongly when combined with a SFA than when used alone in VSMC treatments. This effect was significant only for specific proportions of these FFA and was even more effective in presence of insulin. These results highlight the presence of a competition between pro-apoptotic and anti-apoptotic mechanisms in VSMC that is dependent on FFA ratios (saturated vs. monounsaturated) and on insulinemia. They also underline the importance of the presence of MUFA such as OLA in diets containing high proportions of SFA.