Regulatory T cells and peripheral immune tolerance: key mechanisms and therapeutic strategies for cardiovascular diseases

Cardiovascular diseases (CVDs) remain the leading global cause of disability and mortality, with chronic immune inflammation as their central pathological mechanism. Regulatory T cells (Tregs) and the peripheral immune tolerance they mediate hold a pivotal position and therapeutic potential in CVDs. This review provides a comprehensive overview of Tregs biology, their dysfunction in major CVDs, current therapeutic strategies targeting Tregs, and future directions for achieving immune homeostasis. By moving beyond the traditional focus on numerical deficiency, we highlight the critical role of functional heterogeneity and cellular dysfunction in CVDs pathogenesis, and discuss the emerging therapeutic concept of moving from delaying disease progression to restoring immune homeostasis.