Cardiolipin (CL) is a mitochondria-specific phospholipid and is critical for maintaining the integrity of mitochondrial membrane and mitochondrial function. CL also plays an active role in mitochondria-dependent apoptosis by interacting with cytochrome c (cyt c), tBid and other important Bcl-2 proteins. The unique structure of CL with four linoleic acid side chains in the same molecule and its cellular location make it extremely susceptible to free radical oxidation by reactive oxygen species including free radicals derived from peroxidase activity of cyt c/CL complex, singlet oxygen and hydroxyl radical. The free radical oxidation products of CL have been emerged as important mediators in apoptosis. In this review, we summarize the free radical chemical mechanisms that lead to CL oxidation, recent development in detection of oxidation products of CL by mass spectrometry and the implication of CL oxidation in mitochondria-mediated apoptosis, mitochondrial dysfunction and human diseases.