Chronocardiology and cardiovascular health: a review of circadian rhythms in health and disease

The circadian system is a fundamental regulator of cardiovascular physiology and offers a powerful framework for rethinking strategies for cardiovascular prevention and treatment. In this review, based on a structured literature search of PubMed, Scopus, and Google Scholar (2017–2025) using predefined inclusion criteria, we demonstrate that circadian disruption should be regarded not merely as a risk factor but as an actionable driver of cardiovascular disease, with molecular clocks emerging as clinically relevant biomarkers and therapeutic targets. Advances such as wearable circadian monitoring and chronotherapy trials highlight the growing feasibility of “timing as medicine,” although significant challenges remain. Chief among these is the need for age-specific, patient-tailored approaches that account for the bidirectional interplay between circadian misalignment and common cardiometabolic comorbidities, including metabolic syndrome. Shift work, as a prevalent and persistent source of circadian disruption, underscores the importance of policy-driven workplace reforms to mitigate cardiovascular risks such as non-dipping blood pressure patterns and systemic inflammation. Emerging wearable technologies, increasingly validated for circadian assessment, hold promise for transforming personalized cardiovascular care by enabling real-time monitoring of sleep–wake cycles and vascular health. Future research should prioritize clinical translation through the implementation of circadian biomarkers (e.g., PER2 expression) and the integration of rhythm-guided interventions into public health infrastructure, including revised clinical guidelines for hypertension and metabolic syndrome. By uniting circadian biology with clinical innovation, chronocardiology has the potential to shift cardiology from reactive disease management to proactive, rhythm-informed prevention, thereby reducing the global burden of cardiovascular disease.