[Diabetes and cognitive decline - An often overlooked association]. / Nedsatt kognition och diabetes ­ ett ofta förbisett samband.

In addition to peripheral neuropathy of various manifestations, diabetes is also associated with central neuropathy. This can manifest as premature cognitive decline, although the role of hyperglycemia in this process remains ambiguous. Notwithstanding that the link between diabetes and cognitive decline was discovered 100 years ago, and has important clinical implications, this co-morbidity remains relatively unknown. Recent years have seen research that has clarified cerebral insulin resistance and defective insulin signaling as two putative pathogenic factors behind this cognitive impairment. Recently published studies have shown that physical activity may reverse insulin resistance in the brain as well as improve cognitive impairment and pathological appetite regulation. Pharmacological intervention with e.g. nasal insulin and GLP-1 receptor agonists have also shown promising results, but must be further tested in clinical studies.

[The quest for protective mechanisms against cardiovascular disease]. / Kardiovaskulära händelser ­ varför drabbas inte alla?

In spite of a major risk factor burden or existing co-morbidities certain individuals seem to escape or substantially delay major clinical cardiovascular (CV) events. Besides random variation of disease onset and manifestations it is therefore likely that protective mechanisms exist to postpone or prevent disease. Such processes could involve genetic predisposition, metabolic traits, lifestyle, or other unknown factors. Definition, mapping, and characterization of true protective mechanisms for CV disease by use of omics and biomarkers together with questionnaire data, as well as cardiovascular and metabolic phenotyping in subjects "escaping" a high expected CV risk, might enable identification of potential new drug targets associated with CV protection.

Early Vascular Ageing - A Concept in Development.

Cardiovascular disease (CVD) is a prevalent condition in the elderly, often associated with metabolic disturbance and type 2 diabetes. For a number of years, research dedicated to understand atherosclerosis dominated, and for many good reasons, this pathophysiological process being proximal to the CVD events. In recent years, research has been devoted to an earlier stage of vascular pathology named arteriosclerosis (arterial stiffness) and the new concept of early vascular ageing (EVA), developed by a group of mostly European researchers. This overview describes recent developments in research dedicated to EVA and new emerging aspects found in studies of families at high cardiovascular risk. There are new aspects related to genetics, telomere biology and the role of gut microbiota. However, there is still no unifying definition available of EVA and no direct treatment, but rather only recommendations for conventional cardiovascular risk factor control. New interventions are being developed - not only new antihypertensive drugs, but also new drugs for vascular protection - the selective angiotensin-II (AT2) agonist Compound 21 (C21). Human studies are eagerly awaited. Even new functional food products could have the potential to positively influence cardiometabolic regulation, to be confirmed.