According to the latest Global Burden of Disease Study,
cardiovascular disease (CVD) is the leading cause of death, and
ischemic heart disease and
stroke are the cause of death in approximately half of CVD patients. In CVD,
mitochondrial dysfunction following
ischemia-reperfusion (I/R) injury results in
heart failure. The proper functioning of oxidative phosphorylation (OXPHOS) and the mitochondrial life cycle in cardiac mitochondria are closely related to
mitochondrial DNA (
mtDNA). Following myocardial I/R injury, mitochondria activate multiple repair and clearance mechanisms to repair damaged
mtDNA. When these repair mechanisms are insufficient to restore the structure and function of
mtDNA, irreversible
mtDNA damage occurs, leading to
mtDNA mutations. Since
mtDNA mutations aggravate OXPHOS dysfunction and affect mitophagy,
mtDNA mutation accumulation leads to leakage of
mtDNA and
proteins outside the mitochondria, inducing an innate immune response, aggravating cardiovascular injury, and leading to the need for external interventions to stop or slow the disease course. On the other hand,
mtDNA released into the circulation after cardiac injury can serve as a
biomarker for CVD diagnosis and prognosis. This article reviews the pathogenic basis and related research findings of
mtDNA oxidative damage and
mtDNA leak-triggered innate immune response associated with I/R injury in CVD and summarizes therapeutic options that target
mtDNA.