Apoptosis is a highly programmed cell death strictly connected to the pathogenesis of many human diseases, including neoplastic, neurodegenerative or cardiovascular diseases. Mitochondria play a key role in the apoptotic process; their damage activates a series of events which provoke the release of cytochrome c and other pro-apoptotic factors from the mitochondrial intermembrane space, and culminate in cell death. This review provides an overview of the key role played by mitochondria in the activation of the apoptotic process. In particular, the interest is focused on the role played by cardiolipin, a phospholipid deeply involved in the first steps of the process culminating in cell apoptosis. Mitochondrial phospholipids are involved in several cellular functions, such as cell respiration, apoptosis, and autophagy. Therefore, any alteration in the production of phospholipids or in their structural properties causes deep effects on the cell behavior and induces the arising of different pathologies. The present review summarizes the most recent advances in the study of the role that CL, a phospholipid possessing a unique structure, plays in mitochondrial activity, in apoptosis, and in the onset of human diseases.