Rewiring the cardiovascular epigenome: the multi-target strategy of traditional Chinese medicine

Epigenetic mechanisms, including DNA methylation, histone modifications, and non-coding RNAs (ncRNAs), are fundamentally involved in the initiation and progression of cardiovascular diseases (CVDs). An increasing body of evidence suggests that Traditional Chinese Medicines (TCMs), characterized by multi‑component and multi‑target actions, significantly regulate these epigenetic processes. This review summarizes current advances in TCM‑mediated epigenetic regulation in CVDs and outlines how representative herbs, bioactive compounds, and classical formulations are involved in regulating key epigenetic enzymes, chromatin states, and regulatory RNA networks. Mechanistic evidence across three major epigenetic layers is critically evaluated, and emerging technologies, such as multi-omics profiling, single-cell epigenomics, and CRISPR-based epigenome editing, that have facilitated mechanistic elucidation are summarized. Current limitations, including heterogeneous study designs, insufficient mechanistic validation, and the scarcity of high-quality clinical trials, are discussed in depth. The prospects of integrating TCM with precision epigenetic medicine are further discussed, particularly through biomarker-guided interventions and synergistic combinations with modern therapeutics. A clearer mechanistic framework and standardized methodologies will be required to translate TCM-based epigenetic modulation into clinically actionable strategies for the prevention and treatment of CVDs.