Photobiomodulation for autonomic rebalancing in myocardial infarction prevention

Autonomic nervous system (ANS) imbalance, characterized by chronic sympathetic overactivity and diminished parasympathetic tone, has increasingly been recognized as an important contributor to the pathogenesis of myocardial infarction [1-3]. ANS dysfunction not only affects hemodynamics directly, but also triggers a harmful chain of events. These include insulin resistance, the renin angiotensin aldosterone system (RAAS) activation, systemic inflammation, and endothelial dysfunction [4-6]. Crucially, ANS dysregulation often manifests as a spectrum of prodromal symptoms including altered heart rate variability (HRV), blood pressure lability, visceral discomfort, and functional pain syndromes which provide an identifiable clinical window for early intervention. Targeted modulation of the ANS has thus emerged as a promising strategy for primary prevention [7, 8]. Among non-invasive approaches, photobiomodulation (PBM), particularly in the form of laser acupuncture, represents a novel neuromodulatory tool capable of rebalancing autonomic function [9, 10]. PBM acts through dual pathways: peripherally, by stimulating sensory afferents to reflexively modulate autonomic output, and centrally, by enhancing mitochondrial function, reducing neuroinflammation, and promoting neural plasticity within key brainstem and hypothalamic regulatory centers. These mechanisms may translate into measurable improvements in HRV, reductions in heart rate and blood pressure, attenuation of inflammatory markers, and enhanced vascular function [11,12]. This review proposes autonomic dysfunction as a potential modifiable preclinical window for myocardial infarction (MI) prevention. It positions photobiomodulation (PBM) as a systems-level, non-invasive strategy for autonomic rebalancing and cardiovascular risk reduction, warranting future prospective validation and protocol optimization.