Cardiovascular diseases (CVDs) still remain one of the leading causes of mortality worldwide, requiring novel therapeutic approaches. Steroidal alkaloids, a unique class of naturally bioactive compounds, have showcased promising pharmacological qualities in cardiovascular health. This review article explores the structural classification, pharmacokinetics, and pharmacodynamics properties of such alkaloids, emphasizing their potential therapeutic effects in CVDs. Key cardiovascular activities of these alkaloids include antihypertensive, vasodilatory, antiarrhythmic, and lipid-lowering effects, primarily mediated through receptor interactions, ion channel modulation, and enzyme inhibition. Clinical and preclinical research studies provide preliminary proof of efficacy, though significant research gaps still remain, including very clinical trials and incomplete mechanistic understanding. Furthermore, safety concerns regarding dose-response relationships, toxicity, and drug interactions must be addressed before clinical translation. Novel trends such as, targeted delivery systems, synthetic derivatives and multi-targeted approaches throw light upon the future potential of alkaloids in cardiovascular therapy. This review establishes the need for well-designed clinical trials and structure-activity relationship (SAR) studies to optimize these molecules for cardiovascular drug development. Further research studies integrating omics technologies and exploring the role of steroidal alkaloids in rare cardiovascular disorders could increase their therapeutic applicability.
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