Apoptosis contributes to the progression of various cardiovascular diseases, and inhibiting cardiomyocyte apoptosis is a potential strategy for the treatment of cardiovascular diseases. Caspase is considered to be a major promising target because their induction and execution are critical for evaluating the activation and inhibition of apoptosis. Caspase is used as a common biomarker for different apoptosis pathways [103]. In addition, members of the Bcl-2 family, including pro-apoptotic and anti-apoptotic proteins, play complex roles in myocardial ischemia/reperfusion (I/R) [104-107]. Some traditional Chinese medicine products play a cardioprotective role by inhibiting cardiomyocyte apoptosis. Qiliqiangxin capsule can inhibit the apoptosis of ischemic cardiomyocytes. The underlying mechanism may be related to its ability to reduce ROS and inhibit Fas and caspase 3 expression [108]. Buyinhuanduodang can reduce ventricular remodeling induced by ligation of the left anterior descending branch (LAD) by up-regulating the Bcl-2/Bax ratio and down-regulating the caspase 3 activity [109]. Diosgenin is a saponin extracted from the roots of Huai Yam and Pangolin [110]. Dioscin mitigated cell death in I/ R-stimulated H9C2 cells and reduced lactate dehydrogenase (LDH) levels. Dioscin also attenuates apoptosis by regulating the expression of Bax and Bcl-2. Dioscin also decreased cytochrome c release, intracellular ROS and MDA levels. PNS showed anti-apoptotic effect both in vitro and in vivo. This effect may be mediated by activation of the PI3K/Akt pathway, as the anti-apoptotic effect is neutralized by the PI3K inhibitor LY294002 [112]. Shengmai injection can alleviate endoplasmic reticulum stress and inhibit caspase 12-dependent apoptosis, thereby preventing DOX-induced cardiac dysfunction. Protocatechualdehyde is derived from salvia miltiorrhiza and is a water-soluble antioxidant. Studies have shown that protocatechualdehyde can inhibit lipopolysaccharids-induced apoptosis of human umbilical vein endothelial cells in a dose-dependent manner by regulating the expression of caspase 3.

Some micrornas, such as myocardial specific Mir-1, play a key role in muscle growth, so it can directly affect heart function. Meanwhile, activation of p38 MAPK phosphorylation may lead to myocardial injury and apoptosis. Tanshinone IIA has been shown to have a protective effect against ischemic or hypoxic-induced cardiac injury. This effect is realized by regulating the expression of mir-1 and inhibiting the activation of the p38 MAPK signaling pathway.