DNA methylation-mediated effects of traditional chinese medicine in atherosclerosis: a review

Atherosclerosis (AS), the main pathological basis of cardiovascular and cerebrovascular diseases, is associated with lipid disorders, inflammation, oxidative stress, and vascular smooth muscle cell (VSMC) dysfunction. DNA methylation is a key epigenetic mechanism that plays a pivotal role in regulating the pathological processes of AS. Traditional Chinese medicine (TCM), which has multi-component and multi-target actions, has shown considerable advantages in treating AS through DNA methylation pathways. Natural Chinese herbal medicines with low toxicity and high efficiency can reduce blood pressure, protect vascular endothelial cells, stabilize arterial plaques, and participate in AS prevention and treatment via epigenetic modification, anti-inflammatory, and lipid metabolism-regulating effects. A comprehensive literature review was conducted on PubMed, Web of Science, Google Scholar, and CNKI, focusing on TCM active ingredients and their role in DNA methylation in AS. Our article summarizes the latest research on how TCM and its active components intervene in AS by regulating DNA methylation. Specifically, TCM modulates site-specific DNA methylation to regulate lipid metabolism and foam cell formation, inhibit inflammation, alleviate oxidative stress, and balance phenotypic switching as well as the proliferation and apoptosis of VSMCs. These mechanisms provide novel epigenetic targets for AS treatment beyond conventional lipid-lowering therapies. Integrating advanced technologies with TCM research and developing DNA methylation-targeting agents can improve AS therapy. This cross-disciplinary approach not only enriches the epigenetic regulatory theory of TCM but also paves the way for translating these findings into clinical practice. Our findings offer personalized therapeutic options for AS that do not depend solely on lipid-lowering mechanisms.