Yunfeng Li,* Yulong Ma,* Lei Yao, Jianhua Li, Xunjie Zhou, Mingzhu Wang, Mingtai Gui, Da Li, Xiaozhe Chen, Yidan Dong, Bo Lu, Deyu Fu

Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Bo Lu, Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110, Ganhe Road, Hongkou District, Shanghai, 200437, People’s Republic of China, Email lubo200609@126.com Deyu Fu, Department of Cardiology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, No. 110, Ganhe Road, Hongkou District, Shanghai, 200437, People’s Republic of China, Email fdy650@126.com

Abstract: The global epidemic of obesity and diabetes imposes a significant strain on healthcare systems, substantially elevating the risk of vascular dysfunction and its associated complications. Astragaloside IV (AS-IV) and berberine (BBR) have demonstrated considerable promise in addressing vascular issues linked to these conditions. This review examines the mechanisms driving their vascular protective effects, drawing on evidence from preclinical studies to compare and contrast their modes of action. It explores both the unique and overlapping pathways through which they mitigate the complications of obesity and diabetes. A thorough analysis of their therapeutic potential highlights promising preclinical data and its clinical implications. However, challenges remain, such as enhancing the bioavailability of AS-IV and BBR and translating preclinical findings into robust clinical trials. This synthesis provides critical insights for advancing research and practical approaches in managing vascular dysfunction associated with obesity and diabetes.

Keywords: astragaloside IV, berberine, vascular dysfunction, diabetes, obesity, complications