Cardiovascular Nanomedicine: Breakthroughs in Therapy-Challenges in Safety and Cardiotoxic Risks: A Comprehensive...

The unique physicochemical properties of nanoparticles (NPs) have facilitated the development of targeted therapies for cardiovascular diseases (CVDs). According to World Health Organization estimates, CVDs are the predominant contributors to global mortality, accounting for approximately 17.9 million deaths annually. Conventional treatments, including pharmacological interventions and surgical procedures, face significant barriers such as systemic toxicity due to non-targeted delivery, incomplete efficacy, and high financial burdens. Nanoscale innovations address these limitations through mechanisms such as targeted drug delivery and controlled release. Despite these advancements, concerns regarding NPs-induced cardiotoxicity remain unresolved. As nanomedicine advances rapidly, understanding NP functions within the cardiovascular system is essential for optimizing therapeutic outcomes in parallel to minimize unintended risks. Metal-based NPs, including gold, silver, and iron oxide, have demonstrated promising applications in cardiovascular imaging, regenerative therapy, and drug delivery; however, emerging evidence indicates their potential to induce oxidative stress, inflammatory responses, and endothelial dysfunction, contributing to atherosclerosis, myocardial injury, and arrhythmias. Inhaled and intravenously administered NPs exhibit dose-dependent toxicities that influence mitochondrial function and calcium homeostasis within cardiomyocytes. This review comprehensively analyzes in vitro and in vivo studies and notable clinical trials such as the NANOM-FIM trial. Furthermore, we discuss the role of specific antioxidants in cardioprotection and mitigating NPs-induced cardiotoxicity.