We would like to thank Dr. Nishikawa, Dr. Higaki, and Dr. Yamaguchi for their interest in our recent analysis of the effects of imeglimin on endothelial function [1]. We agree that in patients with diabetes, heart failure with preserved ejection fraction (HFpEF) is an important problem that directly affects life expectancy and quality of life. In terms of cardiac indices of atherosclerosis, Nishikawa and colleagues suggested that we not only focus on the cardio–ankle vascular index (CAVI) and the ankle–brachial index (ABI), but also on the systolic time interval (STI). Therefore, we used the CAVI and ABI data to perform an additional analysis of the STI, calculated as the ratio of the pre-ejection period to the left ventricular ejection time. The results of that analysis showed that the STI did not differ significantly before and 3 months after imeglimin administration (median 0.30, interquartile range [IQR] 0.27–0.35 and median 0.33, IQR 0.31–0.36, respectively; p = 0.266); however, our patient population was small and there may have been too few participants to enable an adequate evaluation of the STI. Nishikawa and colleagues also asked whether the study population included patients with heart failure. We can report that the study included one patient with chronic heart failure who had a history of cardiovascular disease; otherwise, none of the patients had heart failure that was symptomatic or that required medication. Unfortunately, not all patients underwent blood tests to assess cardiac function (e.g., brain natriuretic peptide) or echocardiographic evaluation; thus, the potential incidence of HFpEF in this study population was unknown. We hope that the efficacy of imeglimin in HFpEF will be elucidated in the future.