Counteracting vascular ageing with Traditional Chinese Medicine: Mechanisms at the cellular and molecular levels

With the ageing of the global population, age-related cardiovascular diseases have become a significant burden on global public health. Traditional Chinese Medicine (TCM) possesses a deep theoretical foundation and extensive clinical experience in delaying age-related vascular diseases. However, a systematic synthesis of modern scientific evidence in this field remains lacking. This article provides a systematic review of research progress on the molecular mechanisms of TCM interventions in vascular ageing, focusing on three core dimensions, namely genetic regulation, cellular function and homeostasis, and intercellular communication. The regulatory mechanisms specifically involve telomere integrity, transcriptional function, non-coding RNA regulation, mitochondrial function, oxidative stress, protein post-translational modification, autophagy, immune and inflammatory homeostasis, as well as intercellular communication mediated by the extracellular matrix, extracellular vesicles, and the gut microbiota. Concurrently, TCM modulates vascular ageing through the regulation of vascular smooth muscle cells, endothelial cells, endothelial progenitor cells, macrophages, monocytes and adipocytes. Furthermore, this paper focuses on summarising clinical studies on vascular ageing. These studies involve different types of traditional Chinese medicines and their combinations with synthetic chemical drugs. Moreover, it systematically analyses the strengths and limitations of these medicines in clinical practice.This review aims to synthesise the existing evidence, provide additional TCM treatment options for the global fight against vascular ageing, and promote the development of TCM in this field.