Medicine-food homology substances in cardiovascular disease prevention and management: from mechanisms to clinical evidence and future translation.

Cardiovascular disease (CVD) is the leading global cause of death. "Medicine-food homology" (MFH), a fundamental principle of traditional Chinese medicine (TCM), emphasizes dual nutritional and therapeutic roles of natural substances, thereby attracting increasing attention in disease management. These substances exhibit synergistic effects through multiple targets and signaling pathways, demonstrating significant potential in the prevention, adjuvant therapy, and rehabilitation of CVD. This review presents the mechanisms underlying MFH substances (such as astragalus, codonopsis, and hawthorn) in targeting key pathways related to CVD, and summarizes findings from clinical randomized controlled trials (RCT). This review summarizes MFH substances' role in CVD management, focusing on four core mechanisms (vascular defense, myocardial protection, gut-heart axis regulation, risk factor control) that mediate their multi-targeted, multi-pathway effects (e.g., anti-inflammation via Astragalus, myocardial repair via Ginseng). Clinical evidence confirms MFH substances enhance CVD therapeutic efficacy as adjuvant therapies, with mild adverse reactions, while highlighting the need for further research to advance translational application. Future research should prioritize large-scale multi-center trials, multi-omics integration, and standardized quality control to advance MFH from empirical use to precision medicine, providing new natural product-based strategies for comprehensive CVD prevention and treatment.