Epigenetic Regulation in Cardiovascular Diseases: Mechanisms and Therapeutic Targets

Cardiovascular diseases (CVDs) arise as the product of multiple factors, including genetic predisposition and environmental exposure, but the molecular and cellular interplays underlying such a pathogenetic process leading to sustained pathological conditions remain largely unknown. A growing body of evidence indicates that epigenetic mechanisms, including DNA methylation, histone modifications, chromatin remodeling, noncoding RNAs, and RNA modifications, are important for cardiovascular development, adaptation, and disease. However, findings from these studies are fragmented across different genomic contexts or disease-focused scenarios, lacking systematic integration for a global view connecting epigenetic dynamics to cardiovascular phenotypes and their clinical implications. An overall picture of epigenetic modulation in CVDs is therefore provided. Common epigenetic mechanisms are described in a cell type and disease stage-specific context, and the roles of environmental and lifestyle factors in remodeling the cardiovascular epigenome are illustrated. Novel epigenetic biomarkers and therapeutic interventions are also assessed. Emphasis is placed on epigenomic plasticity, enhancer focused control, and network-level reprogramming as key concepts that drive disease remodeling. By unifying mechanistic understanding with translational evidence, this review frames CVD as a disorder of stabilized regulatory states and defines avenues for precision epigenomic manipulation.