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Xinyi Shen,1,2 Ge Guo,1,2 Guoquan Feng,3 Zhongqun Wang1,2 1Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People’s Republic of China; 2Institute of Cardiovascular Diseases, Jiangsu University, Zhenjiang, 212001, People’s Republic of China; 3Imaging Department, Affiliated Hospital of Jiangsu University, Zhenjiang, 212000, People’s Republic of ChinaCorrespondence: Zhongqun Wang, Email wangtsmc@126.comIntroduction: Vascular calcification is a major cause of cardiovascular accidents in patients with type 2 diabetes mellitus. This study aimed to investigate the impact of carbohydrates on gut microbiota and aortic calcification in diabetic ApoE−/− mice.Methods: The diabetic ApoE−/− mice were randomly divided into 4 groups: ketogenic diet group, low carbohydrate diet group, medium carbohydrate diet group, and high carbohydrate diet group. The mice were fed continuously for 6 months, with blood glucose, blood ketone and body weight monitored monthly. Lipid metabolism indicators and inflammatory factors were detected using ELISA. The intestinal barrier, atherosclerotic lesion areas, and vascular calcifications were analyzed based on their morphology. Gut microbiota was analyzed using 16S rRNA genes.Results: We found that ketogenic diet played some roles improving glucose, lipid metabolism, and inflammation. Ketogenic diet could improve the intestinal barrier to some extent and increase intestinal bacteria. Compared to the other three groups, the relative abundance of genus Allobaculum, species Blautia producta and Clostridium Ramosum in the ketogenic diet group was significantly increased (P < 0.05), which has protective effects in diabetic ApoE−/− mice.Conclusion: Ketogenic diet could delay the onset of aortic atherosclerosis, aortic calcification and improve intestinal barrier function in diabetic ApoE−/− mice. Keywords: diabetes mellitus, atherosclerosis, vascular calcification, gut microbiota, low-carb die

Wenhua Yu, Zhongqun Wang Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of ChinaCorrespondence: Zhongqun Wang, Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China, Email wangtsmc@126.com

Xiabo Wang,1 Zhongqun Wang,1 Jianqiang He2 1Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People’s Republic of China; 2Department of Nephrology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People’s Republic of ChinaCorrespondence: Jianqiang He, Department of Nephrology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People’s Republic of China, Email hejq0305@163.com Zhongqun Wang, Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, 212001, People’s Republic of China, Email wangtsmc@126.com; wangzhongqun@ujs.edu.cnAbstract: Presently, the mechanism of occurrence and development of vascular calcification (VC) is not fully understood; a range of evidence suggests a positive association between diabetes mellitus (DM) and VC. Furthermore, the increasing burden of central vascular disease in patients with chronic kidney disease (CKD) may be due, at least in part, to VC. In this review, we will review recent advances in the mechanisms of VC in the context of CKD and diabetes. The study further unveiled that VC is induced through the stimulation of pro-inflammatory factors, which in turn impairs endothelial function and triggers similar mechanisms in both disease contexts. Notably, hyperglycemia was identified as the distinctive mechanism driving calcification in DM. Conversely, in CKD, calcification is facilitated by mechanisms including mineral metabolism imbalance and the presence of uremic toxins. Additionally, we underscore the significance of investigating vascular alterations and newly identified molecular pathways as potential avenues for therapeutic intervention. Keywords: chronic kidney disease, vascular calcification, diabetes mellitus

Wenhua Yu,1 Bo Yang,1 Siting Xu,1 Yun Gao,2 Yan Huang,3 Zhongqun Wang1 1Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China; 2Department of Pathology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China; 3Department of Ophthalmology, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of ChinaCorrespondence: Zhongqun Wang; Yan Huang, Affiliated Hospital of Jiangsu University, Zhenjiang, People’s Republic of China, Tel +86-15262919468, Email wangtsmc@126.com; wangzhongqun@ujs.edu.cn; 0511syj@163.comAbstract: Diabetic complications can be divided into macrovascular complications such as cardiovascular disease and cerebrovascular disease and microvascular complications such as diabetic retinopathy, diabetic nephropathy and diabetic neuropathy. Among them, cardiovascular disease (CVD) is an important cause of death in diabetic patients. Diabetes retinopathy (DR) is one of the main reasons for the increasing disability rate of diabetes. In recent years, some studies have found that because DR and CVD have a common pathophysiological basis, the occurrence of DR and CVD are inseparable, and to a certain extent, DR can predict the occurrence of CVD. With the development of technology, the fundus parameters of DR can be quantitatively analyzed as an independent risk factor of CVD. In addition, the cytokines related to DR can also be used for early screening of DR. Although many advances have been made in the treatment of CVD, its situation of prevention and treatment is still not optimistic. This review hopes to discuss the feasibility of DR in predicting CVD from the common pathophysiological mechanism of DR and CVD, the new progress of diagnostic techniques for DR, and the biomarkers for early screening of DR.Keywords: diabetic retinopathy, cardiovascular disease, pathophysiological mechanism, optical coherence tomography angiography, biomarkers