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Cardiovascular diseases (CVDs) continue to be the world's leading cause of death, driven by intricate processes such as inflammation, endothelial dysfunction, oxidative stress, and apoptosis. MicroRNAs (miRNAs), small non-coding RNAs that influence mRNA translation, have become recognized as key regulators of these harmful mechanisms in conditions like heart attack, heart failure, and atherosclerosis. Because they remain stable in the bloodstream, miRNAs hold promise as convenient, minimally invasive biomarkers for early CVD detection, assessing risk, and forecasting outcomes. On the treatment side, targeting miRNAs offers a way to correct disrupted molecular pathways with precision, though moving this approach into clinical use presents hurdles such as refining delivery methods, avoiding unintended effects, and achieving specificity for certain tissues. Current studies emphasize progress in understanding how miRNAs contribute to CVD development and their emerging potential in personalized care. Yet, translating these findings into routine practice will require overcoming technical challenges and establishing consistent standards. This evolving area holds great potential to transform cardiovascular medicine through precise diagnostics and targeted therapies, potentially addressing current shortcomings in treatment effectiveness.