Bridging tradition and modernity: mitochondrial dynamics as a Traditional Chinese Medicine therapeutic target in cardiovascular disease

BACKGROUND: A pathological link exists between mitochondrial fission/fusion imbalance and cardiovascular disease (CVD). Traditional Chinese Medicine (TCM), based on concepts such as "Qi stagnation and blood stasis" and "Yin-Yang imbalance," helps balance mitochondrial function through the combined effects of multiple components, providing a comprehensive treatment approach for CVD. AIMS OF THE STUDY: To methodically clarify the molecular processes by which TCM formulations, extracts, and bioactive compounds target mitochondrial dynamics to intervene in CVD over the past five years, highlighting their ethnopharmacological significance in "multi-component and multi-target" synergistic actions. METHODS: This study searched PubMed, Web of Science, Wanfang, and VIP databases (2019-2024), using the Boolean search formula: ("cardiovascular disease" OR "CVD") AND ("mitochondrial dynamics" OR "mitochondrial fission" OR "mitochondrial fusion") AND ("Traditional Chinese Medicine" OR "TCM") AND ("active compounds" OR "bioactive components"). After deduplication with EndNote, 183 articles were systematically screened and included, comprising in vitro experiments using cardiomyocyte models, in vivo studies based on animal models of CVD, and mechanistic investigations utilizing ex vivo tissues or cellular experiments (all human clinical trials were excluded). RESULTS: Formulations such as Buyang Huanwu Decoction (BYHWD) and Qishen Yiqi Dropping Pills (QSYQ) improved heart conditions by reducing dynamin-related protein 1 (Drp1) overactivity and increasing mitofusin 2 (Mfn2) and optic atrophy 1 (OPA1) levels. Bioactive compounds, such as salidroside(Sal), prevented Drp1 from causing mitochondria to split apart by activating the AMP-activated protein kinase(AMPK)/Sirtuin 1(SIRT1) pathway, while astragaloside IV facilitated better mitochondrial fusion to enhance energy utilization. CONCLUSION: TCM manages mitochondria dynamics through multi-target mechanisms, connecting "overall treatment" with "specific targeting" for heart disease therapy. Further ethnopharmacological translation requires standardized screening of bioactive components and the development of innovative drug delivery systems. The study suggests a "Traditional Chinese Medicine-Mitochondrial Dynamics Intervention Model (TCM-MDIM)," which combines organelle-level mitochondrial regulation with the principle of balancing blood and qi to offer novel approaches to the targeted therapy of cardiovascular disorders.