Panax ginseng C.A. Mey. as Multi-Target Regulators of Vascular Homeostasis: Pharmacological Mechanisms and Therapeutic Perspectives

Cardiovascular and cerebrovascular diseases (CVDs) are closely associated with disturbances in vascular homeostasis, including endothelial dysfunction, abnormal vascular remodeling, inflammation, oxidative stress, thrombosis, barrier disruption, and dysregulated angiogenesis. Ginsenosides, the major bioactive saponins of Panax ginseng C.A. Mey., have been reported to modulate several of these processes. This review integrates structural, pharmacokinetic, bioinformatic, and experimental evidence to evaluate the vascular actions of representative ginsenosides. Preclinical studies indicate partially overlapping effects on endothelial integrity, vascular tone, permeability, inflammatory and oxidative responses, hemostasis, remodeling, and angiogenesis. Structural differences and biotransformation may contribute to variation in exposure and pharmacological profiles. However, most evidence derives from isolated compounds tested in heterogeneous cell and animal models, direct comparisons or combination studies are limited, and several in vitro concentrations exceed plasma levels reported after oral ginseng administration. The proposed multi-target network should therefore be regarded as hypothesis-generating rather than evidence of coordinated restoration of vascular homeostasis. Future studies should emphasize exposure-relevant experimental designs, comparative assessment of individual ginsenosides and defined combinations, and pharmacokinetic–target engagement relationships.