Non-Coding RNAs in Vascular Calcification: Regulatory Networks, Functional Diversity, and Therapeutic Insights

Vascular calcification is an ectopic calcium salt deposition process that lacks effective treatment under pathological conditions such as chronic kidney disease, diabetes, and aging. This review, for the first time, systematically categorizes miRNAs involved in the regulation of vascular calcification according to signaling pathways, clearly revealing the regulatory nodes and crosstalk among different pathways (Wnt/β catenin, BMP/Smad, NF κB, etc.), thereby providing a pathway-level theoretical basis for precision targeting. It also dissects the functional duality and microenvironment dependency of miRNAs—the same miRNA can exert opposite effects in different contexts, suggesting that miRNA-based drug development must focus on disease-selective targeted delivery to avoid the risk of functional reversal. This article further comprehensively summarizes the heterogeneous regulatory patterns of lncRNAs, the unique regulatory modes of circRNAs, and preliminary evidence suggesting the involvement of emerging non-coding RNAs (piRNAs, tsRNAs) and integrates the potential of circulating non-coding RNAs as non-invasive biomarkers and prospects for targeted therapeutic translation. This review provides a panoramic view of the network-based regulation of vascular calcification by non-coding RNAs, laying a theoretical foundation for precision diagnosis and multi-target combination intervention.