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Among them, 15.5% with type 1 diabetes mellitus (T1DM) have abnormal myocardial systolic or diastolic function, whereas patients with type 2 diabetes mellitus (T2DM) are mostly middle-aged and elderly, with a relatively higher risk of cardiovascular system complications ( Ferroptosis is a new type of programmed cell death that is often accompanied by massive iron accumulation and lipid peroxidation, as well as a deficiency in oxidoreductases, especially glutathione peroxidase 4 (GPX 4 ) ( 4 directly or indirectly through different pathways, causing a decrease in cellular antioxidant capacity and accumulation of lipid reactive oxygen species (ROS), ultimately leading to cell death ( In recent years, studies have shown that ferroptosis is strongly associated with various diseases including ischemic heart disease, kidney disease, liver damage, degenerative diseases, and diabetes ( 2 Roles and regulatory mechanisms of ferroptosis 2.1 Ferroptosis and iron metabolism Iron is an important nutrient in the human body and is involved in a variety of biological processes, such as oxygen transport, lipid metabolism, DNA and protein synthesis, and cellular respiration

Altogether, this indicates that agents that induce ferroptosis through TrxR inhibition might affect multiple pathways or proteins in addition to the thioredoxin pathway, and these could contribute to anti-tumor effects and compatibility with chemotherapy