Abstract
Heart failure (HF), as the terminal stage of various cardiovascular diseases, remains a global health challenge with persistently high morbidity and mortality rates. Although current therapies-including angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter-2 inhibitors, and cardiac resynchronization therapy-have improved outcomes, significant limitations persist. Ginseng, a renowned traditional Chinese medicine, contains bioactive ginsenosides (e.g., Rb1, Rb3, Re, Rg1, and Rg3) that exhibit multitarget cardioprotective effects, offering a promising therapeutic strategy for HF. This review systematically elucidates the mechanisms by which ginsenosides ameliorate HF, including modulation of myocardial energy metabolism, suppression of oxidative stress and inflammation, attenuation of fibrosis, and inhibition of cardiomyocyte apoptosis. We further evaluate the synergistic efficacy of ginsenoside-containing formulations (e.g., YiQiFuMai injection and Qiliqiangxin capsule) in HF management. Although clinical evidence remains limited and heterogeneous, preclinical studies robustly support ginsenosides as pleiotropic natural compounds with therapeutic potential for HF. Future research should prioritize high-quality clinical trials, optimize delivery systems (e.g., nanocarriers), and explore combination therapies with conventional drugs to accelerate clinical translation.