Clinical needs and translational prospects of cardiovascular nanomedicine: Focus on intravascular and molecular imaging of atherosclerosis

Cardiovascular disease (CVD) remains the leading global cause of mortality, despite major advances in interventional and pharmacological therapies. Recent insights suggest that limitations in current treatments stem from insufficient targeting of molecular and cellular drivers of disease. Nanomedicine-a rapidly evolving discipline that integrates nanoscale materials for diagnosis, therapy, and molecular imaging-offers transformative potential for CVD management. This review highlights the critical clinical needs in cardiovascular care and outlines emerging nanotechnological solutions, including vascular nanotherapy, myocardial regeneration strategies, and advanced imaging techniques such as near-infrared fluorescence intravascular ultrasound (NIRF-IVUS). We discuss recent preclinical and translational breakthroughs in molecular imaging of protease activity, macrophage phenotypes, and oxidized low-density lipoprotein (oxLDL), with a focus on the implications for plaque characterization and therapeutic intervention. While several nanomedical approaches remain at the investigational stage, early clinical evidence-such as from the NANOM-FIM trial-demonstrates safety and efficacy of nanoparticle-based therapies in vascular disease. To bridge the gap between innovation and clinical application, interdisciplinary collaboration and strategic investment are essential. Nanomedicine holds significant promise to reshape cardiovascular diagnostics and therapeutics by enabling molecular-level precision within familiar procedural platforms.