Targeting lipophagy in atherosclerosis: Molecular mechanisms, pathogenesis and therapeutic interventions (Review)

Atherosclerosis (AS) is a chronic inflammatory disease characterized by lipid accumulation within the arterial wall. The imbalance between cholesterol influx and efflux, coupled with persistent inflammation, drives the progression of plaque formation. Lipophagy, a selective form of autophagy, specifically targets lipid droplets for lysosomal degradation. Consequently, this process is a notable regulator of cellular lipid homeostasis. In the present review, the core regulatory networks of lipophagy were systematically summarized, including the mechanistic target of rapamycin complex 1/AMP‑activated protein kinase, transcription factor EB (TFEB) and farnesoid X receptor/cAMP response element‑binding protein signaling axes. The multidimensional roles of lipophagy in key cell types involved in AS are also discussed. For example, in macrophages, lipophagy stabilizes plaques by promoting cholesterol efflux and inhibiting foam cell formation; however, dysregulated lipophagy can exacerbate necrotic core formation. In vascular smooth muscle cells, lipophagy regulates phenotype switching and calcification and in endothelial cells, lipophagy mitigates oxidative stress and inflammation. Advances in therapeutic strategies targeting lipophagy were evaluated, ranging from pharmacological agents (such as statins and metformin) to natural compounds (such as berberine and geniposide) and Traditional Chinese Medicine formulas. In conclusion, targeting lipophagy represents a pivotal therapeutic frontier for stabilizing atherosclerotic plaques; however, the broad application of autophagy inducers lacks precision. Future strategies should transition from generalized modulation to cell‑type specific interventions that precisely calibrate the sirtuin 1‑TFEB‑lipophagy axis. Furthermore, elucidating the 'double‑edged' role of lipophagy in late‑stage plaque outcomes is required for developing safe, clinically translatable modulators.