Doxorubicin (DOX) is a widely used anthracycline anticancer agent; however, its dose-dependent and cumulative cardiotoxicity severely limits its long-term clinical use. Danshen (Salviae Miltiorrhizae Radix et Rhizoma) and Salviae Miltiorrhizae Radix et Rhizoma-based preparations have shown potential for the prevention and treatment of DOX-induced cardiotoxicity in both experimental and clinical studies. This review systematically summarizes the cardioprotective mechanisms of Salviae Miltiorrhizae Radix et Rhizoma extracts, active constituents (including tanshinone I, tanshinone II_A, and salvianolic acid B), Salviae Miltiorrhizae Radix et Rhizoma-containing herbal formulas, and Chinese patent medicines, with particular emphasis on their inhibitory effects on oxidative stress, apoptosis, pyroptosis, inflammation, and other pathological processes. Unlike previous reviews that have focused primarily on individual active constituents or the general cardiovascular protective effects of Salviae Miltiorrhizae Radix et Rhizoma, this review compares the pharmacological characteristics and mechanistic differences among different Salviae Miltiorrhizae Radix et Rhizoma-derived components in DOX-induced cardiotoxicity. Based on the current evidence, key barriers to clinical translation are further discussed to provide a reference for the clinical application and drug development of Salviae Miltiorrhizae Radix et Rhizoma-derived therapies.

Salviae Miltiorrhizae Radix et Rhizoma  /  doxorubicin  /  cardiotoxicity  /  oxidative stress  /  inflammation