Redox imbalance and oxidative stress in cardiovascular diseases: mechanisms, biomarkers, and therapeutic targets

Cardiovascular diseases (CVDs) are the leading cause of global morbidity and mortality, with oxidative stress and redox imbalance playing pivotal roles in their initiation and progression. In this comprehensive review, we explore the molecular mechanisms by which reactive oxygen and nitrogen species disrupt vascular homeostasis, promote endothelial dysfunction, and drive adverse cardiac remodeling. We highlight key redox-sensitive pathways, including NADPH oxidase activation, mitochondrial dysfunction, endothelial nitric oxide synthase uncoupling, and endoplasmic reticulum stress. Emerging oxidative stress biomarkers, such as 8-iso-prostaglandin F2α, oxidized low-density lipoprotein, and myeloperoxidase, are critically examined for their diagnostic and prognostic relevance. Additionally, we discuss therapeutic strategies targeting oxidative stress, ranging from conventional antioxidants to novel mitochondrial-directed and enzyme-specific interventions. Despite advances in understanding the redox landscape of CVDs, challenges remain in translating these insights into effective clinical therapies. Future research integrating omics technologies, precision medicine, and combined lifestyle-pharmacological approaches may offer new opportunities for redox-based cardiovascular interventions.