Ferroptosis of smooth muscle cells in vascular diseases: from basic principles to clinical translation

Vascular smooth muscle cells (VSMCs), which form the media layer of blood vessels, play a vital role in vascular homeostasis and remodeling. Dysfunction of VSMCs represents a key pathological basis and an important contributor to vascular diseases. Ferroptosis, an iron-dependent accumulation of lipid hydroperoxides, is a novel form of regulated cell death. VSMC ferroptosis is involved in a range of vascular diseases, such as atherosclerosis, vascular calcification, hypertension, aortic aneurysm, aortic dissection, neointimal hyperplasia, intracranial aneurysm, and pulmonary arterial hypertension. This review summarizes the current evidence, underlying potential mechanisms, and therapeutic targets of VSMC ferroptosis in vascular diseases. A deeper understanding of this process may provide therapeutic insights and help in mitigating cardiovascular risk in affected patients.