Natural Compounds Targeting Coronary Microvascular Dysfunction: Mechanisms and Beyond

Coronary microvascular dysfunction (CMD) is increasingly recognized as a major public health burden, independently contributing to myocardial ischemia, adverse cardiovascular events, and elevated healthcare costs. Its pathophysiology is multifactorial, involving endothelial dysfunction, microthrombosis, and metabolic disturbances. Natural compounds, owing to their multi-target effects and favorable safety profiles, have emerged as promising candidates for CMD intervention. This narrative review systematically consolidates current evidence on the key molecular targets and regulatory mechanisms through which natural compounds preserve microvascular homeostasis. It also highlights shared pathological pathways between CMD and other cardiovascular diseases to support cross-disease therapeutic translation. By integrating these findings, this review aims to establish a theoretical foundation for future preclinical and clinical applications of natural compounds in CMD management.