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Diabetic nephropathy (DN) represents a significant microvascular complication in diabetes, entailing intricate molecular pathways and mechanisms associated with cardiorenal vascular diseases. Prolonged hyperglycemia induces renal endothelial dysfunction and damage via metabolic abnormalities, inflammation, and oxidative stress, thereby compromising hemodynamics. Concurrently, fibrotic and sclerotic alterations exacerbate glomerular and tubular injuries. At a macro level, reciprocal communication between the renal microvasculature and systemic circulation establishes a pernicious cycle propelling disease progression. The current management approach emphasizes rigorous control of glycemic levels and blood pressure, with renin-angiotensin system blockade conferring renoprotection. Novel antidiabetic agents exhibit renoprotective effects, potentially mediated through endothelial modulation. Nonetheless, emerging therapies present novel avenues for enhancing patient outcomes and alleviating the disease burden. A precision-based approach, coupled with a comprehensive strategy addressing global vascular risk, will be pivotal in mitigating the cardiorenal burden associated with diabetes. [ABSTRACT FROM AUTHOR]

Panvascular disease is not only a common comorbidity of type 2 diabetes mellitus (T2DM), but also the leading cause of disability and death in patients with T2DM. To promote multidisciplinary cooperation, interdisciplinary integration, and early detection of panvascular diseases in T2DM patients, a panel composed of Chinese experts in cardiovascular disease, endocrinology, nephrology, neurology, and health management led by Chinese College of Cardiovascular Physicians was established and developed this consensus based on the latest evidence‑based medical research and crucial progress in the related disciplines. This consensus covers the epidemiological characteristics, pathophysiological mechanisms, multidisciplinary collaborative diagnosis and treatment, as well as risk assessment and management, and highlights the early risk assessment of panvascular disease in patients with T2DM (assess risk factors, vascular structure and function, and target organ damage at least annually). This consensus also emphasizes that managing panvascular disease in patients with T2DM requires the participation of both patients and multidisciplinary physicians and the necessity of strengthening the control of blood glucose, blood pressure, blood lipids, and antiplatelet therapy based on lifestyle interventions. The consensus will standardize the comprehensive clinical management of panvascular disease in patients with T2DM and improve patient prognosis. [ABSTRACT FROM AUTHOR]

BackgroundPatients with lower extremity arteriosclerosis obliterans (LEASO) are more likely to appear to be associated with adverse cardiovascular outcomes. Currently, few studies have reported the sex-specific characteristics and risk of major cardiovascular and cerebrovascular adverse events (MACCEs) in LEASO. Our study was conducted to determine the characteristics and contributions of LEASO to MACCEs in males and females.MethodsWe conducted a single-center retrospective study of consecutively enrolled patients with first-diagnosed LEASO at Renmin Hospital of Wuhan University from November 2017 to November 2019. The ratio of patients between the LEASO and control groups was 1 to 1 and based on age, sex, comorbid diabetes mellitus and hypertension, current smoking and medications. The occurrence of MACCEs was used as the primary endpoint of this observational study.ResultsA LEASO group (n = 430) and control group (n = 430) were enrolled in this study. A total of 183 patients experienced MACCEs during an average of 38.83 ± 14.28 months of follow-up. Multivariate Cox regression analysis indicated that LEASO was an independent predictor of the occurrence of MACCEs in all patients (HR: 2.448, 95% CI: 1.730–3.464, P < 0.001). Subgroup analysis by sex subgroup was conducted for sex, and LEASO was also an independent predictor of the occurrence of MACCEs in both male cases (HR: 2.919, 95% CI: 1.776–4.797, P < 0.001) and female cases (HR: 1.788, 95% CI: 1.110–2.880, P = 0.017). Moreover, Kaplan–Meier analysis indicated no significant difference in event-free survival between patients of different sexes with LEASO (χ2 = 0.742, P = 0.389).ConclusionLEASO tended to a useful risk stratified indicator for MACCEs in both male and female patients in our study. Notably, attention should be given to patients with LEASO who should undergo comprehensive cardiovascular evaluation and intervention, even if there is a lack of traditional cardiovascular risk factors.

Diabetic nephropathy (DN) represents a significant microvascular complication in diabetes, entailing intricate molecular pathways and mechanisms associated with cardiorenal vascular diseases. Prolonged hyperglycemia induces renal endothelial dysfunction and damage via metabolic abnormalities, inflammation, and oxidative stress, thereby compromising hemodynamics. Concurrently, fibrotic and sclerotic alterations exacerbate glomerular and tubular injuries. At a macro level, reciprocal communication between the renal microvasculature and systemic circulation establishes a pernicious cycle propelling disease progression. The current management approach emphasizes rigorous control of glycemic levels and blood pressure, with renin-angiotensin system blockade conferring renoprotection. Novel antidiabetic agents exhibit renoprotective effects, potentially mediated through endothelial modulation. Nonetheless, emerging therapies present novel avenues for enhancing patient outcomes and alleviating the disease burden. A precision-based approach, coupled with a comprehensive strategy addressing global vascular risk, will be pivotal in mitigating the cardiorenal burden associated with diabetes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Zhang, Ren, Sun and Zhai.)

Background: Patients with lower extremity arteriosclerosis obliterans (LEASO) are more likely to appear to be associated with adverse cardiovascular outcomes. Currently, few studies have reported the sex-specific characteristics and risk of major cardiovascular and cerebrovascular adverse events (MACCEs) in LEASO. Our study was conducted to determine the characteristics and contributions of LEASO to MACCEs in males and females., Methods: We conducted a single-center retrospective study of consecutively enrolled patients with first-diagnosed LEASO at Renmin Hospital of Wuhan University from November 2017 to November 2019. The ratio of patients between the LEASO and control groups was 1 to 1 and based on age, sex, comorbid diabetes mellitus and hypertension, current smoking and medications. The occurrence of MACCEs was used as the primary endpoint of this observational study., Results: A LEASO group ( n = 430) and control group ( n = 430) were enrolled in this study. A total of 183 patients experienced MACCEs during an average of 38.83 ± 14.28 months of follow-up. Multivariate Cox regression analysis indicated that LEASO was an independent predictor of the occurrence of MACCEs in all patients (HR: 2.448, 95% CI: 1.730-3.464, P < 0.001). Subgroup analysis by sex subgroup was conducted for sex, and LEASO was also an independent predictor of the occurrence of MACCEs in both male cases (HR: 2.919, 95% CI: 1.776-4.797, P < 0.001) and female cases (HR: 1.788, 95% CI: 1.110-2.880, P = 0.017). Moreover, Kaplan-Meier analysis indicated no significant difference in event-free survival between patients of different sexes with LEASO (χ 2 = 0.742, P = 0.389)., Conclusion: LEASO tended to a useful risk stratified indicator for MACCEs in both male and female patients in our study. Notably, attention should be given to patients with LEASO who should undergo comprehensive cardiovascular evaluation and intervention, even if there is a lack of traditional cardiovascular risk factors., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sun, Deng, Wang, Duan, Chen, Zhou, Zhou, Yu, Guo, Liu, Xu, Song, Wang, Feng and Yu.)

As a first-line treatment for diabetes, the insulin-sensitizing biguanide, metformin, regulates glucose levels and positively affects cardiovascular function in patients with diabetes and cardiovascular complications. Endothelial dysfunction (ED) represents the primary pathological change of multiple vascular diseases, because it causes decreased arterial plasticity, increased vascular resistance, reduced tissue perfusion and atherosclerosis. Caused by "biochemical injury", ED is also an independent predictor of cardiovascular events. Accumulating evidence shows that metformin improves ED through liver kinase B1 (LKB1)/5'-adenosine monophosphat-activated protein kinase (AMPK) and AMPK-independent targets, including nuclear factor-kappa B (NF-κB), phosphatidylinositol 3 kinase-protein kinase B (PI3K-Akt), endothelial nitric oxide synthase (eNOS), sirtuin 1 (SIRT1), forkhead box O1 (FOXO1), krüppel-like factor 4 (KLF4) and krüppel-like factor 2 (KLF2). Evaluating the effects of metformin on endothelial cell functions would facilitate our understanding of the therapeutic potential of metformin in cardiovascular diabetology (including diabetes and its cardiovascular complications). This article reviews the physiological and pathological functions of endothelial cells and the intact endothelium, reviews the latest research of metformin in the treatment of diabetes and related cardiovascular complications, and focuses on the mechanism of action of metformin in regulating endothelial cell functions., Competing Interests: Competing Interests: The authors have declared that no competing interest exists., (© The author(s).)