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Cardiovascular Disease and Diabetes: A New Challenge in Treatment and Management

A special issue of International Journal of Molecular Sciences (ISSN 1422-0067). This special issue belongs to the section "Molecular Pathology, Diagnostics, and Therapeutics".

Deadline for manuscript submissions: 20 November 2025 | Viewed by 8877

Special Issue Editor

Dr. Graziano Riccioni

E-Mail Website
Guest Editor
Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Manfredonia, FG, Italy
Interests: hypertension; atherosclerosis; heart congestive failure; dyabetes mellitus; therapy; hypercholesterolemia; coronary artery disease
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Alterations in major hormonal patterns frequently impact patients with cardiovascular disease (CVD); examples include disorders of thyroid function in the context of arrhythmology or pituitary and adrenal pathologies in the context of the more resistant forms of hypertension, but—among them all—diabetes plays a preponderant role.

The diabetes is the main risk factor for the development of CVD, but at the same time, CVD is the leading cause of death in patients with diabetes. The close relationship between diabetes and the heart seems immediately clear.

With the proper control of blood sugar, blood lipids, and blood pressure, the risk of CVD disease will be attenuated, but it cannot be completely suppressed. Therefore, more research is needed to understand the molecular mechanisms and interactions between diabetes and CVD, which will help reduce the burden of CVD and diabetes treatment.

An interdisciplinary evaluation allows the choice of the best therapy for patients with diabetes. The knowledge of cardiologic risk allows not only to adopt the most effective medication for diabetes control, but also the most suitable medication to reduce the risk of heart attack and/or decompensation; on the other hand, recognizing the presence and severity of diabetes allows the cardiologist to manage certain cardiovascular pathologies.

The purpose of this Special Issue is to provide useful tools in the field that treat CVD and diabetes for the proper monitoring and treatment of diabetes in patients with cardiovascular pathologies (e.g., chronic ischemic heart disease, heart failure, arterial hypertension, etc.).

Dr. Graziano Riccioni
Guest Editor

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Keywords

  • hypertension
  • atherosclerosis
  • congestive heart failure
  • diabetes mellitus
  • therapy
  • hypercholesterolemia
  • coronary artery disease

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Published Papers (4 papers)

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Research

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16 pages, 661 KB  
Article
Comparative Evaluation of ARB Monotherapy and SGLT2/ACE Inhibitor Combination Therapy in the Renal Function of Diabetes Mellitus Patients: A Retrospective, Longitudinal Cohort Study
by Andrew W. Ngai, Aqsa Baig, Muhammad Zia, Karen Arca-Contreras, Nadeem Ul Haque, Veronica Livetsky, Marcelina Rokicki and Shiryn D. Sukhram
Int. J. Mol. Sci. 2025, 26(15), 7412; https://doi.org/10.3390/ijms26157412 - 1 Aug 2025
Viewed by 1118
Abstract
Diabetic nephropathy affects approximately 30–40% of individuals with diabetes mellitus (DM) and is a major contributor to end-stage renal disease (ESRD). While angiotensin II receptor blockers (ARBs) have long served as a standard treatment, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have recently gained attention for [...] Read more.
Diabetic nephropathy affects approximately 30–40% of individuals with diabetes mellitus (DM) and is a major contributor to end-stage renal disease (ESRD). While angiotensin II receptor blockers (ARBs) have long served as a standard treatment, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have recently gained attention for their renal and cardiovascular benefits. However, comparative real-world data on their long-term renal effectiveness remain limited. We conducted a retrospective, longitudinal study over a 2-year period to compare the impact of ARB monotherapy versus SGLT2i and angiotensin-converting enzyme inhibitor (ACEi) combination therapy on the progression of chronic kidney disease (CKD) in patients with DM. A total of 126 patients were included and grouped based on treatment regimen. Renal biomarkers were analyzed using t-tests and ANOVA (p < 0.01). Albuminuria was qualitatively classified via urinalysis as negative, level 1 (+1), level 2 (+2), or level 3 (+3). The ARB group demonstrated higher estimated glomerular filtration rate (eGFR) and lower serum creatinine (sCr) levels than the combination therapy group, with glycated hemoglobin (HbA1c), potassium (K+), and blood pressure remaining within normal limits in both cohorts. Albuminuria remained stable over time, with 60.8% of ARB users and 73.1% of combination therapy users exhibiting persistently or on-average negative results. Despite the expected additive benefits of SGLT2i/ACEi therapy, ARB monotherapy was associated with slightly more favorable renal function markers and a lower incidence of severe albuminuria. These findings suggest a need for further controlled studies to clarify the comparative long-term renal effects of these treatment regimens. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Diabetes: A New Challenge in Treatment and Management)
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Review

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18 pages, 401 KB  
Review
Treatment of Dyslipidemia in Patients with Type 1 Diabetes Mellitus: A Review of Current Evidence and Knowledge Gaps
by Viviana Elian, Alina Dorita, Daniela Stegaru and Dragos Vinereanu
Int. J. Mol. Sci. 2025, 26(17), 8558; https://doi.org/10.3390/ijms26178558 - 3 Sep 2025
Viewed by 668
Abstract
Type 1 diabetes (T1D) is a chronic condition with an increasing prevalence worldwide and a significant improvement in life expectancy in the last decades. T1D confers an increased risk of cardiovascular events, driven by elevated LDL cholesterol (LDL-C) and qualitative lipoprotein abnormalities, such [...] Read more.
Type 1 diabetes (T1D) is a chronic condition with an increasing prevalence worldwide and a significant improvement in life expectancy in the last decades. T1D confers an increased risk of cardiovascular events, driven by elevated LDL cholesterol (LDL-C) and qualitative lipoprotein abnormalities, such as dysfunctional HDL and smaller, denser LDL-C. Lipid-lowering outcome trials have overwhelmingly focused on type 2 diabetes or the general population, resulting in very limited T1D-specific evidence. Recommendations from major medical associations (ADA, ESC/EAS, ACC/AHA, ISPAD) create additional ambiguity regarding the treatment of dyslipidemia in T1D. This review synthesizes the available evidence on dyslipidemia management in T1D, including published observational cohorts, randomized controlled trials, and international guideline recommendations from January 2000 to June 2025. LDL-C remains the primary modifiable risk factor. Each 1 mmol/L increase is associated with 35–50% greater cardiovascular (CV) risk in T1D cohorts. Statin therapy reduces CV risk by up to 25% in patients with diabetes; however, evidence remains limited in patients with T1D. Ezetimibe provides an additional 18% LDL-C lowering and a 14% event reduction in mixed-diabetes trials, while PCSK9 inhibitors offer a potent 40–60% LDL-C reduction and an 18% MACE reduction. The uptake of statins in eligible adults with T1D remains below 50%. Statins remain the cornerstone of dyslipidemia management in T1D, with emerging evidence supporting ezetimibe and PCSK9 inhibitors. The heterogeneity across international guidelines and the scarcity of T1D-specific outcome data underscore the need for targeted research and evidence-based strategies. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Diabetes: A New Challenge in Treatment and Management)
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22 pages, 2743 KB  
Review
SGLT2 Inhibitors in Cancer Patients: A Comprehensive Review of Clinical, Biochemical, and Therapeutic Implications in Cardio-Oncology
by Alessandra Greco, Maria Laura Canale, Vincenzo Quagliariello, Stefano Oliva, Andrea Tedeschi, Alessandro Inno, Marzia De Biasio, Irma Bisceglia, Luigi Tarantini, Nicola Maurea, Alessandro Navazio, Marco Corda, Attilio Iacovoni, Furio Colivicchi, Massimo Grimaldi and Fabrizio Oliva
Int. J. Mol. Sci. 2025, 26(10), 4780; https://doi.org/10.3390/ijms26104780 - 16 May 2025
Cited by 4 | Viewed by 2148
Abstract
Patients with active cancer and cancer survivors are at a markedly increased risk for developing cardiovascular comorbidities, including heart failure, coronary artery disease, and renal dysfunction, which are often compounded by the cardiotoxic effects of cancer therapies. This heightened cardiovascular vulnerability underscores the [...] Read more.
Patients with active cancer and cancer survivors are at a markedly increased risk for developing cardiovascular comorbidities, including heart failure, coronary artery disease, and renal dysfunction, which are often compounded by the cardiotoxic effects of cancer therapies. This heightened cardiovascular vulnerability underscores the urgent need for effective, safe, and evidence-based cardioprotective strategies to reduce both cardiovascular morbidity and mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2is), a class of drugs originally developed for the treatment of type 2 diabetes, have demonstrated significant cardiovascular and renal benefits in high-risk populations, independent of glycemic control. Among the currently available SGLT2i, such as empagliflozin, canagliflozin, dapagliflozin, and sotagliflozin, there is growing evidence supporting their role in reducing major adverse cardiovascular events (MACEs), hospitalization for heart failure, and the progression of chronic kidney disease. Recent preclinical and clinical data suggest that SGLT2is exert cardioprotective effects through multiple mechanisms, including the modulation of inflammasome activity, specifically by reducing NLRP3 inflammasome activation and MyD88-dependent signaling, which are critical drivers of cardiac inflammation and fibrosis. Moreover, SGLT2is have been shown to enhance mitochondrial viability in cardiac cells, promoting improved cellular energy metabolism and function, thus mitigating cardiotoxicity. This narrative review critically evaluates the emerging evidence on the cardiorenal protective mechanisms of SGLT2is, with a particular focus on their potential role in cardio-oncology. We explore the common pathophysiological pathways between cardiovascular dysfunction and cancer, the molecular rationale for the use of SGLT2is in cancer patients, and the potential benefits in both primary and secondary prevention of cardiovascular toxicity related to oncological treatments. The aim is to propose a therapeutic paradigm utilizing SGLT2is to reduce cardiovascular mortality, MACE, and the burden of cardiotoxicity in high-risk oncology patients, fostering an integrated approach to cardio-oncology care. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Diabetes: A New Challenge in Treatment and Management)
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22 pages, 802 KB  
Review
Advances in the Insulin–Heart Axis: Current Therapies and Future Directions
by Alfredo Caturano, Erica Vetrano, Raffaele Galiero, Celestino Sardu, Luca Rinaldi, Vincenzo Russo, Marcellino Monda, Raffaele Marfella and Ferdinando Carlo Sasso
Int. J. Mol. Sci. 2024, 25(18), 10173; https://doi.org/10.3390/ijms251810173 - 22 Sep 2024
Cited by 7 | Viewed by 4161
Abstract
The insulin–heart axis plays a pivotal role in the pathophysiology of cardiovascular disease (CVD) in insulin-resistant states, including type 2 diabetes mellitus. Insulin resistance disrupts glucose and lipid metabolism, leading to systemic inflammation, oxidative stress, and atherogenesis, which contribute to heart failure (HF) [...] Read more.
The insulin–heart axis plays a pivotal role in the pathophysiology of cardiovascular disease (CVD) in insulin-resistant states, including type 2 diabetes mellitus. Insulin resistance disrupts glucose and lipid metabolism, leading to systemic inflammation, oxidative stress, and atherogenesis, which contribute to heart failure (HF) and other CVDs. This review was conducted by systematically searching PubMed, Scopus, and Web of Science databases for peer-reviewed studies published in the past decade, focusing on therapeutic interventions targeting the insulin–heart axis. Studies were selected based on their relevance to insulin resistance, cardiovascular outcomes, and the efficacy of pharmacologic treatments. Key findings from the review highlight the efficacy of lifestyle modifications, such as dietary changes and physical activity, which remain the cornerstone of managing insulin resistance and improving cardiovascular outcomes. Moreover, pharmacologic interventions, such as metformin, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and dipeptidyl peptidase-4 inhibitors, have shown efficacy in reducing cardiovascular risk by addressing metabolic dysfunction, reducing inflammation, and improving endothelial function. Furthermore, emerging treatments, such as angiotensin receptor–neprilysin inhibitors, and mechanical interventions like ventricular assist devices offer new avenues for managing HF in insulin-resistant patients. The potential of these therapies to improve left ventricular ejection fraction and reverse pathological cardiac remodeling highlights the importance of early intervention. However, challenges remain in optimizing treatment regimens and understanding the long-term cardiovascular effects of these agents. Future research should focus on personalized approaches that integrate lifestyle and pharmacologic therapies to effectively target the insulin–heart axis and mitigate the burden of cardiovascular complications in insulin-resistant populations. Full article
(This article belongs to the Special Issue Cardiovascular Disease and Diabetes: A New Challenge in Treatment and Management)
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