Abstract:Vulnerable atherosclerotic plaque rupture leading to thrombosis is the major cause of acute coronary syndromes. While early detection or prevention the vulnerable plaque would be the only way to reduce the risk of this catastrophic life-threatening event, there is frustratingly little progress in either. Lack of suitable animal models has considerably hampered the research progress in understanding the mechanisms occurring in the development of plaque rupture. This review summarizes the currently available vulnerable plaque animal models and invasive and noninvasive imaging modalities used to detect vulnerable plaques, including high frequency duplex ultrasound, coronary tomographic angiography (CTA), magnetic resonance imaging (MRI), intravascular ultrasound (IVUS), optical coherence tomography (OCT), intravascular ultrasound elastography, and inflammatory markers.

Abstract:Aim To investigate the influence of calcitonin gene-related peptide (CGRP) on the survival activity of c-kit^pos cardiac stem cells(c-kit⁺ CSC) in hypoxia, and research its potential mechanism. Methods c-kit⁺ CSC was obtained by enzyme digestion and immune magnetic bead separation. Then serum-free hypoxia model of c-kit⁺ CSC was established in vitro. The models were randomly divided into hypoxia group, CGRP+hypoxia group, CGRP+CGRP₈-37+hypoxia group and control group(no hypoxia). The activity of cells was detected by cell counting kit (CCK-8 kit),the apoptosis of cells were detected by flow cytometry(FCM) and mitochondrial membrane potential. Results Under hypoxia condition,compared with the control group,the activity of c-kit⁺ CSC was significantly decreased in the hypoxia group(P<0.05),but compared with the hypoxia group,the activity of c-kit⁺ CSC was significantly increased in CGRP+hypoxia group at different time points of CGRP effect on hypoxia cells(P<0.05), especially in 30 min and 60 min; When inhibiting the effect of CGRP on hypoxia, compared with CGRP+hypoxia group,the activity of c-kit⁺ CSC was significantly decreased in the CGRP+CGRP₈-37+hypoxia group at 30 min and 60 min after hypoxia(P<0.05). In terms of apoptosis, compared with the control group,the early apoptosis rate was the highest in hypoxia group(P<0.05); After CGRP treating c-kit⁺ CSC in hypoxia, we could find that CGRP+hypoxia group had a lower early apoptosis rate(P<0.05), when inhibiting the effect of CGRP on hypoxia, the early apoptosis rate was the highest in CGRP+CGRP₈-37+hypoxia group, but there was no significant difference in early apoptosis rate between hypoxia group and CGRP+CGRP₈-37+hypoxia group(P>0.05). Mitochondrial membrane potential showed, compared with the hypoxia group, red fluorescence and green fluorescence ratio increased in CGRP+hypoxia group(P<0.05), when inhibiting the effect of CGRP on hypoxia, compared with the CGRP+hypoxia, the red fluorescence and green fluorescence ratio decreased in CGRP+CGRP₈-37+hypoxia group(P<0.05). Conclusion CGRP can promote the proliferation and survival of c-kit⁺CSC under hypoxia, and inhibit the early apoptosis of the cell.

Abstract:Aim To investigate the effect and potential mechanism of atorvastatin on the THP-1 macrophage proinflammatory cytokines release induced by lipopolysaccharide (LPS). Methods THP-1 cells were treated with phorbol 12-myristate 13-acetate (100 nmol/L) for 24 h to differentiate into macrophages. The medium was then replaced with serum-free medium containing LPS and (or) atorvastatin. The secretion of interleukin-1β (IL-1β) and interleukin-18 (IL-18) were quantitated using enzyme-linked immunosorbent assay analysis. The mRNA level of nucleotide-binding oligomerization domain-like receptor protein 1 (NLRP1) inflammasome was measured by real-time PCR. Western blot was employed to analyze the protein expression of NLRP1 inflammasome. Results Atorvastatin inhibited IL-1β and IL-18 secretion induced by LPS in THP-1 macrophages in a dose- and time-dependent manner. Atorvastatin decreased the mRNA and protein expression of NLRP1 inflammasome in THP-1 macrophages. Conclusion Atorvastatin reduces proinflammatory cytokines release from macrophages, and the mechanism might be related to the inhibition of NLRP1 inflammasome expression.

Abstract:Aim To investigate whether high blood glucose-induced vascular calcification in diabetes mellitus is caused by the endoplasmic reticulum(ER) response and subsequent apoptosis. Methods We examined the effects of high glucose on the ER stress response and calcification of vascular smoothmuscle cells (VSMC). Alkaline phosphatase (ALP) activity, calcium content and osteogenic markers expression was measured by colorimetric assay, o-cresolphthalein method and Western blot analysis. Results High glucose induced osteoblastic differentiation and ER stress of VSMC,as evidenced by ALP activity, calcium content and osteogenic markers expression increase. 4-PBA treatment could inhibit ER stress and apoptosis of VSMC, therefore, high glucose-elicited VSMC calcification was retarded. Conclusion High glucose can activate ER stress and osteoblastic differentiation in VSMC, ER stress and apoptosis might mediate VSMC calcification induced by high glucose.

Abstract:Aim To investigate the change of ambulatory blood pressure (BP) for 7 days after admission and its impact on the prognosis for patients with acute hemorrhage stroke. Methods 141 patients with new onset acute hemorrhage stroke were enrolled. The 7-day/24-hour (24 h) ambulatory BP was monitored and the odd points of time of BP were collected per two hours. Related clinical data of patients were collected. The prognosis of patients was determined according to the 30-day Glasgow outcome scale (GOS) after admission, and the relationships of prognosis and ambulatory BP changes such as admission systolic BP (SBP) and diastolic BP (DBP), 7-day daytime/nighttime mean SBP and DBP, 7-day BP circadian rhythm (BPCR) changes etc, were analyzed. Results 7-day/24-h mean BP decreased gradually among patients with new onset acute hemorrhage stroke. The BP on the seventh day was significantly lower than that on the first day (P＜0.05). There was no significant difference in BPCR between two groups (P＞0.05). There were significant difference between two groups in 7-day/24-h BP, admission Glasgow coma scale (GCS), white blood cells (WBC), hospital days, midline shift, broken into the ventricle, history of hypertension, and admission SBP(P＜0.05). Multivariate logistic regression showed that admission high 24-h mean SBP, low admission GCS, high WBC, big amount of bleeding, basal ganglia hemorrhage were the risk factors for the poor prognosis of acute hemorrhage stroke (P＜0.05). Conclusion 7-day/24-h BP was higher in the poor prognosis group among patients with new onset acute hemorrhage stroke, and admission severe disease, big basal ganglia hemorrhage, high admission 24-h SBP were indicators for the severity of condition and poor prognosis. Monitoring and control of admission 24-h SBP and the amount of bleeding are beneficial for improving the prognosis of acute hemorrhage stroke.

Abstract:Aim To investigate the influence of diabetes on the long-term prognosis in patients with coronary heart disease (CHD) treated by percutaneous coronary intervention (PCI). Methods A total of 2367 consecutive patients with CHD treated by PCI were selected. According to whether there was diabetes, the patients were divided into two groups:diabetes group (n＝719) and non-diabetes group (n＝1648). The influence of diabetes on the long-term prognosis of patients with CHD after PCI was studied by the COX regression analysis. Results Compared with the non-diabetes group, the rate of male patients and level of high density lipoprotein cholesterol (HDLC) were lower, the levels of triglyceride and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were higher, the proportions of old myocardial infarction (OMI), cardiac dysfunction, hypertension, renal dysfunction and cerebral apoplexy were higher in the diabetes group. The proportion of coronary three-vessel lesion, chronic occlusion ratio and Gensini score were higher, average number of stents was more and the average length of stent was longer in the diabetes group. Postoperative follow-up showed that there was no significant difference on all-cause mortality, major adverse cardiovascular event (MACE), cardiac death, nonfatal myocardial infarction and unplanned repeat revascularization between the two groups. Multivariate COX regression analysis showed that there was no significant correlation between diabetes and long-term prognosis of patients with PCI. Conclusions PCI patients with diabetes have special clinical characteristics, but the long-term prognosis is not significantly adverse.

Abstract:Aim To analyze the correlation factors of achilles tendon thickness in patients with hypercholesterolemia, and offer comprehensive prevention and treatments for patients with hypercholesterolemia accompanied by achilles tendon thickening. Methods 104 patients (50 males and 54 females) with hypercholesterolemia, aged between 18 and 70 years old, were enrolled into this study from March 2014 to March 2015. They were divided into achilles tendon thickening group of 41 cases and achilles tendon normal group of 64 cases, comparing the differences of general clinical data between the two groups, and single and multiple regression analysis were made to assess the correlation factors of achilles tendon thickness in hypercholesterolemia patients. Results There existed significant difference in body weight (63.70±11.16 kg vs. 56.45±9.96 kg), height (162.91±6.48 cm vs. 160.08±6.90 cm), body mass index (24.03±3.30 kg/m² vs. 22.17±2.83 kg/m²), the level of TC (8.47±1.39 mmol/L vs. 7.67±1.94 mmol/L), the level of LDLC (6.14±0.99 mmol/L vs. 5.12±0.13 mmol/L), the level of HDLC (1.17±0.42 mmol/L vs. 1.97±1.31 mmol/L) and the level of apolipoprotein AI (1.18±0.26 mmol/L vs. 1.62±0.21 mmol/L) between the achilles tendon thickening group and the achilles tendon normal group in patients with hypercholesterolemia. Univariate Logistic regression analysis showed that the achilles tendon thickness had significant difference in different height (OR＝1.4,5%CI was 1.002~1.129), body mass index (OR＝1.1,5%CI was 1.064~1.390), TC (OR＝1.1,5%CI was 1.014~1.715), HDLC(OR＝0.8,5%CI was 0.007~0.115), LDLC (OR＝2.5,5%CI was 1.494~3.807), ApoAI(OR＝0.6,5%CI was 0.001~0.046) in hypercholesterolemia patients. Multiple Logistic regression analysis showed that LDLC (OR＝1.1,5%CI was 1.067~3.280) was risk factor while HDLC(OR＝0.9,5%CI was 0.017~0.573) and apolipoprotein AI (OR＝0.5,5%CI was 0.003~0.412) were protective factors of achilles tendon thickness in hypercholesterolemia patients. Conclusion The hypercholesterolemia patients with thickened achilles tendon thickness have higher serum cholesterol levels. Serum LDLC is the independent risk factor while HDLC and apolipoprotein AI are protective factors in patients with hypercholesterolemia. So it is imperative to take intensive treatment in hypercholesterolemia patients accompanied with thickened achilles tendon thickness.

Abstract:Aim To investigate the application value of high-resolution magnetic resonance imaging technology of three-dimensional volumetric isotropic turbo spin echo acquisition (3D-VISTA) on detecting cerebral microbleeds (CMB). Methods 65 patients with cerebral amyloid angiopathy were retrospectively analyzed and carefully observed. In addition, all images were analyzed, and sieved from the class of being qualified and above. The present study detects the CMB by comparing two techniques to the “golden standard” susceptibility weighted imaging (SWI), in order to assess the coherence of those techniques. And all CMBs were assessed by partitions and graded. Results Some cases of patients could not be applied because the images were unqualified, and the number of GRE sequence, SWI sequence and 3D-VISTA sequence were 6,2 and 38, which could be applied. The results of 3D-VISTA sequence and SWI sequence had high consistency on detecting CMB of cerebral amyloid angiopathy (CAA) patients, and the Kappa value was 0.6113.Conclusions The high-resolution magnetic resonance imaging technology of 3D-VISTA had expressed high accuracy in the diagnosis of CMB of CAA patients. The proposed technique of 3D-VISTA can be applied to detect the CAA, and it provides a useful noninvasive method for the diagnosis of CAA.

Abstract:Aim To analyse correlation between postprandial hypotension(PPH) of breakfast and morning blood pressure surge in essential hypertension patients. Methods 135 patients with essential hypertension who proceed 24 h ambulatory blood pressure were divided into non-PPH group(n=45), and postprandial hypotension of breakfast group(PPH-1 group)(n=45), and postprandial hypotension of lunch and dinner(PPH-2 group)(n=45). Average blood pressure, blood pressure load values, dipper rate, blood pressure variability and morning surge were observed in three groups. Results (1)24hSBPV, 24hDBPV, dSBPV, dDBPV, nSBPV of PPH-1 group was obviously higher than that of the non-PPH and PPH-2 group, and the difference was statistically significant(P＜0.05).(2)The morning surge value and morning blood pressure surge ratio of the PPH-1 group was significantly higher than that of non-PPH and PPH-2 group(P＜0.05).(3)Preprandial SBP was positively correlated with postprandial fall in SBP after meal(r=0.548,P＜0.001).Breakfast preprandial SBP was positively correlated with postprandial fall in SBP after breakfast(r=0.623,P＜0.001). Conclusion The higher the preprandial blood pressure, the more prone to PPH, breakfast postprandial hypotension patients have a higher blood pressure variability, morning surge phenomenon happens more easily.

Abstract:Aim To investigate the relationship between serum level of periostin and prognosis of patients with acute myocardial infarction (AMI). Methods Serum periostin was measured by using enzyme-linked immunosorbent assay in 178 patients with AMI immediately after hospitalization. All patients were followed up for 12 and 18 months. Major adverse cardiac and cerebrovascular events (MACCE) were counted, including death, stroke/transient ischemic attack, recurrent chest pain, ischemia and re-admission. The relationship between the level of periostin and the prognosis of cardiovascular disease was evaluated. Results Follow-up results showed that MACCE composite end-point in high periostin group of AMI patients was higher than that in low periostin group after 12 months follow-up (P＜0.05). Recurrent chest pain, ischemia and re-admission, and MACCE composite end-point in high periostin group were higher than those in low periostin group after 18 months follow-up (P＜0.05). The results suggested that the serum level of the periostin might be used as an index to predict the prognosis of patients with myocardial infarction. Conclusion The serum level of periostin may be related to the prognosis of cardiovascular disease in patients with AMI.

Abstract:Aim To evaluate the imaging features of transcranial Doppler(TCD) in cerebral infarction patients with epileptic seizures during r-tissue-type plasminogen activator(rt-PA) thrombolysis and analyze the risk factors of epileptic seizures. Methods 120 patients with cerebral infarction were selected to the research subjects. All patients received the rt-PA thrombolytic therapy. According to the occurrence of the epileptic seizures, the patients were divided into two groups: epileptic seizures group(53 cases) and simple cerebral infarction group(67 cases). The imaging features of TCD were compared between two groups. The correlations of the clinical factors to the occurrence of the epileptic seizures were analyzed by univariate Logistic regression analysis and multivariate Logistic regression analysis. ResultsTCD examination results showed that the intracranial arterial stenosis, incomplete or occlusion rate was 30.19% and the poor collateral circulation rate was 73.58% in epileptic seizures group. And the intracranial arterial stenosis, incomplete or occlusion rate was 23.88% and the poor collateral circulation rate was 29.85% in simple cerebral infarction group. The collateral circulation in epileptic seizures group was significantly worse than that in simple cerebral infarction group(P＜0.05). The rate of abnormal blood flow velocity was 69.81% in epileptic seizures group, and 32.84% in simple cerebral infarction group, and the difference was significant between the two groups(χ²＝69.20, P＜0.01). Univariate Logistic analysis showed that the ischemic site and NIHSS score were correlated with epileptic seizures(P＜0.05). Multivariate Logistic analysis showed that the cortical ischemia and high NIHSS score were risk factors of epileptic seizures(P＜0.05).Conclusions The cortical ischemia and high NIHSS score were the susceptible factors to cerebral infarction patients with secondary epileptic seizures. In the course of rt-PA thrombolysis, TCD should be applied to inspect the collateral circulation and blood flow velocity and judge the degree of cerebral vascular stenosis, which is as a basis for the treatment of antiepileptic drugs.

Abstract:Aim To investigate the relationship between reactive hyperemia index(RHI) and blood homocysteine (Hcy) or carotid intima-media thickness (IMT) in patients with unstable angina pectoris(UAP). Methods A total of 245 consecutive patients taken coronary angiography(CAG)were enrolled in this study, and then divided, according to CAG, into normal group (n=65), SAP group (n=49) and UAP group (n=131). Vascular endothelial function was reviewed and RHI was calculated by using peripheral arterial tension (PAT) detection with Endo-PAT2000 (Itamar Medical Inc). IMT were measured with Color Doppler, and serum Hcy level was determined with enzymatic cycling assay. Results The RHI was significantly lower in UAP group than in the SAP group and normal group (UAP group＜SAP group＜normal group,P＜0.05);IMT was significantly higher in the UAP group than in SAP group or in normal group (UAP group＞SAP group＞normal group,P＜0.05);Hcy was significantly higher in UAP group than in normal group(P＜0.05); In UAP group,RHI was negatively correlated with serum Hcy level and carotid IMT (r=－0.494,r=－0.513,P＜0.01); Multiple linear regression analysis showed that it was independently correlated between IMT(X1), systolic pressure(X2), BMI(X3) and RHI(Y) in patients with UAP. Conclusion The serum Hcy level and IMT are positively associated with endothelial dysfunction(ED) in UAP patients, the serum Hcy level, IMT and RHI are correlated with the condition of patients with coronary heart disease.

Abstract:Aim To study the beneficial effects of high dose atorvastatin sequential treatment in preventing contrast-induced nephropathy (CIN) in acute non-ST-segment elevation acute myocardial infarction (NSTEMI) patients underwent elective percutaneous coronary intervention (PCI). Methods One hundred patients with NSTEMI undergone elective PCI were randomly divided into two groups:high dose atorvastatin sequential treatment group (sequential treatment group for short) and control group. All patients were given 80 mg atorvastatin instantly and then 40 mg once a day. On the basis of hydration therapy, sequential treatment group received additional 40 mg atorvastatin at 6 hours before PCI. Serum creatinine (Scr), endogenous creatinine clearance rate (Ccr) and the incidence rate of CIN were measured and compared 24 hours and 48 hours post-PCI. Results The levels of Scr, Ccr had no significant difference in the two groups at all time points. Compared with the preoperative, Scr and Ccr had no significant changes postoperatively in sequential treatment group. In control group, Scr and Ccr had no significant change 24 hours postoperatively, Scr had significantly increased, Ccr had significantly decreased after 48 hours (P＜0.05). Compared with 24 h postoperatively, Scr had significantly increased, Ccr had significantly decreased (P＝0.00). Scr decreased to the normal range after 7~10 days in all patients with CIN. The CIN incidence rate had no significant difference in the two groups (16% vs. 15%, P＝0.585). Conclusion For patient who had used lipid-lowering program before PCI:40 mg/d atorvatatin, the strategy of re-load atorvastatin 40 mg can not reduce the CIN incidence rate.

Abstract:Aim To construct the lentivirus expression vector of overexpression for RagB gene, realize the overexpression of RagB gene in C2C12 cells, test the regulation of mammalian target of rapamycin (mTOR) activation mediated by Ursolic acid. Methods The lentivirus expression vectors, Flag pLJM1 RagBWT, Flag pLJM1 RagB⁵⁴L and Flag pLJM1 RagB⁹⁹L were employed in the experiment. Using PCR to amplify the full length of Flag-RagBWT, Flag-RagB⁵⁴L and Flag-RagB⁹⁹L, then they were subcloned into the pWPI lentivirus vector through SwaI restriction site and identified by bacteria liquid PCR. The cloned lentivirus vectors(pWPI-RagBWT, pWPI-RagB⁵⁴L and pWPI-RagB⁹⁹L) were packaged with packaging vectors (psPAX2 and pMD2.G) via specific ratio and transfected into 293T cells. 48 hours after the transfection, the media was collected and used to infect C2C12 cells. RagB⁹⁹L-overexpressed C2C12 myoblasts were treated individually or jointly with leucine and ursolic acid, mTOR activation was detected by Western blot. Results The efficiency of infection observed by fluorescence microscope was almost 100%, the expression of RagB in C2C12 cells proved by Western blot was enhanced significantly in RagB overexpression group. Ursolic acid inhibited significantly mTOR activation in RagB⁹⁹L-overexpressed C2C12 myoblasts. Conclusion The results indicate that RagB can be overexpressed in C2C12 cells by constructing the lentivirus expression vector, RagB plays a critical role in ursolic acid-inhibited mTOR activation.

Abstract:Aim To investigate the dyslipidemia distribution of population aged 45 and over and related factors in Shunqing District,Nanchong City,providing scientific basis for the prevention and treatment of dyslipidemia. Methods Select 27 000 residents aged 45 and above from 8 communities in Shunqing District,Nanchong City,and investigate the lipid levels and influencing factors by questionnaires, medical examinations and dietary survey. The results were analyzed by chi-square or t-test and multivariate Logistic regression analysis. Results The dyslipidemia detection rate ,awareness rate, treatment rate and control rate was 45.7%,7.2%,2.3% and 0.5%,respectively.Women accounted for 55.72% in the dyslipidemia population, 44.28% for men,and there existed a statistically significant difference between them(P<0.05). Univariate analysis showed that:dyslipidemia was related to age, education level, smoking history, family history of hypertension, family history of diabetes, family history of dyslipidemia, hypertension, diabetes, exercise, eating fried pasta, height, weight,body mass index,waist circumference,hip circumference,eating fresh fruits in male and related to age, smoking history, family history of dyslipidemia, hypertension, diabetes, potato consumption, weight, body mass index, waist circumference, hip circumference in female. Multivariate Logistic regression analysis found that:smoking, family history of dyslipidemia, hypertension, diabetes, exercise, eating fried foods, weight, BMI, waist circumference were risk factors, and age and education were protective factors in male;family history of dyslipidemia, hypertension, diabetes, potato consumption, weight, BMI, waist circumference were risk factors in female. Conclusion The dyslipidemia situation of the population aged 45 and over in Shunqing District,Nanchong City is not optimistic. We need to establish a comprehensive chronic disease management services model including dyslipidemia urgently,which will improve knowledge and skills of patient self-management,and reduce or delay the occurrence of cardiovascular events.

Abstract:Aim To investigate the correlation between the 24 hours ambulatory systolic blood pressure (SBP) and brachial-ankle pulse wave velocity (baPWV) in the elderly. Methods The first health examination for in-service and retired staff in Kailuan Group Company was performed from 2006 to 2007, with the second, third health examination from 2008 to 9,0 to 2011 respectively. At the third health examination, a cluster random sample of 2814 cases ≥60 years old and retired employees was selected, and ambulatory blood pressure, baPWV, etc. were examined. 2464 cases met the inclusion criteria, and 1004 cases had complete data. Multivariate linear regression analysis was used to analyze the correlation between 24hSBP, day SBP, night SBP and baPWV. Results (1)Research subjects were divided into three groups according to 24hSBP, day SBP and night SBP tertiles. baPWV was increased with the increase of 24hSBP, day SBP and night SBP (all P＜0.001). (2)Multivariable linear regression analysis showed that when 24hSBP, day SBP, night SBP increased 1 standard deviation, BaPWV was increased by 81.5,3.8,1.30 cm/s, after adjustment for confounding factors. In addition, the diagnosis room SBP also showed a linear positive correlation with baPWV, and the regression coefficient of diagnosis room SBP was larger than that of ambulatory SBP. Conclusion 24hSBP, day SBP and night SBP are positively correlated with baPWV, but the correlation was weaker than that of diagnosis room SBP.

Abstract:G protein-coupled receptor 5 (TGR5) is recently discovered to be a new membrane receptor that can regulate inflammation and metabolism. TGR5 activation can inhibit foam cell formation and atherosclerotic plaque rupture by reducing inflammation reaction, promote NO, H₂S and other endogenous gas signal molecules to improve vascular endothelial dysfunction. In addition, it also can reduce atherosclerosis risk factors such as obesity and diabetes. Therefore, TGR5 may be an important target for prevention and treatment of atherosclerosis.

Abstract:Carotid stenosis is closely related to occurrence of ischemic stroke. It is very important to locate and grade carotid stenosis rapidly and exactly for treatment plan and prognosis. Many studies have demonstrated that the carotid stenosis can be assessed accurately by color Doppler ultrasonography, which is the preferred noninvasive means for clinic.

Abstract:Psoriasis and atherosclerosis are both chronic inflammatory diseases, and share the common basic lesion of “plaque”, which affect different target organs. Clinical epidemiological studies suggest the correlations between psoriasis and atherosclerosis, and those in immunologic pathogenesis are reviewed in this essay from the perspective of immunological mechanisms and inflammatory pathways.

Abstract:The patients with metabolic syndrome or type 2 diabetes mellitus are characterized by insulin resistance and have more risks to develop extensive atherosclerosis, even it occurs before hyperglycemia. Atherosclerosis is the leading cause of death in diabetic population. Thus it is important to explore the mechanisms of atherosclerosis. Besides the traditional risk factors, C-peptide which is considered no biological activity may play role in atherogenesis. It involves inflammation of artery and results in monocyte/macrophage accumulation as well as smooth muscle cell proliferation. Several cohort studies suggest that increased C-peptide levels relate to all-cause death, cardiovascular disease and cancer mortality.This review focuses on the new biological functions of C-peptide based on in vitro, vivo research and clinical studies.