Cellular and Molecular Mechanisms of Hyperglycemia-Induced Atherosclerosis and Intervention Strategies of Chinese Herbal Medicine

Diabetes is a significant global public health issue, and atherosclerosis serves as the primary pathological basis for the occurrence and progression of cardiovascular and cerebrovascular events. Studies have shown that hyperglycemia can promote the occurrence and progression of atherosclerosis by damaging vascular endothelial cells, macrophages, and vascular smooth muscle cells. In recent years, Chinese herbal medicines and their active ingredients have demonstrated unique advantages in preventing and treating high-glucose-induced vascular cell damage. Their mechanisms of action primarily encompass two aspects: firstly, regulating blood glucose through multiple pathways such as modulating the insulin signaling pathway, enhancing peripheral glucose uptake and utilization, and delaying intestinal carbohydrate absorption; secondly, intervening in key pathological processes such as high-glucose-induced vascular cell inflammation, cell death, phenotypic transformation, and metabolic reprogramming. This, in turn, slows down the progression of diabetes-related atherosclerosis. This article systematically elucidates the molecular mechanisms underlying hyperglycemia-induced damage to vascular endothelial cells, macrophages, and vascular smooth muscle cells. It also summarizes the protective mechanisms of Chinese herbal medicine active ingredients (albiflorin, salvianolic acid B, scutellarin, vitexin, hydroxysafflor yellow A, ginsenoside Rb1, maslinic acid, paeonol, citronellal, matrine, Panax notoginseng saponins, astragalus polysaccharides, 6-gingerol, and sodium tanshinone IIA sulfonate) and traditional Chinese medicine compounds (buyang huanwu decoction, guanxining tablets, and fufang zhenzhu tiaozhi) against vascular endothelial cells, macrophages, and vascular smooth muscle cells. The aim is to provide a theoretical basis for the prevention and treatment of diabetes-related atherosclerosis, as well as the development of related therapeutic drugs.