Mitochondria-targeted nanotechnology in cardiovascular diseases: a review of recent advances

Cardiovascular diseases (CVDs) remain the leading cause of global mortality, with mitochondrial dysfunction serving as a central pathological hub in conditions such as atherosclerosis, myocardial ischemia-reperfusion injury and heart failure. Current mitochondrial-regulating drugs are severely limited by low bioavailability, short duration of action, poor targeting specificity and off-target effects, highlighting an urgent need for precise delivery systems. Nanocarriers, with tunable physicochemical properties and surface functionalization potential, enable hierarchical targeting of diseased cardiac tissues and mitochondria, offering a novel solution to overcome these limitations. Preclinical models have shown promising efficacy, particularly in alleviating oxidative stress damage in ischemic cardiomyopathy, improving energy metabolism in heart failure and promoting tissue repair. These encouraging results have sparked growing interest in the application of nanomaterials for mitochondrial-targeted diagnosis and treatment of CVDs. This review first outlines the role of mitochondrial dysfunction in CVD pathogenesis, covering impaired oxidative phosphorylation, excessive reactive oxygen species production, disrupted mitochondrial dynamics and defective mitophagy. It, then, focuses on the design strategies of nanotherapeutics based on a hierarchical targeting concept, encompassing the selection of biocompatible carriers, optimization of size and morphology, tissue or cell-specific targeting modifications, mitochondrial ligand modifications, as well as the loading and therapeutic mechanisms of various therapeutic agents. Furthermore, it provides an in-depth analysis of key physiological barriers such as hemodynamic shear stress, endothelial barrier and extracellular matrix hindrance, along with intracellular trafficking challenges including lysosomal escape and immune clearance, which all impact delivery efficiency. This review aims to offer insights to advance the rational development and clinical translation of mitochondria-targeted nanomedicines for CVDs.