Intermedin (IMD) or adrenomedullin 2 is a novel peptide related to the calcitonin gene-related peptide (CGRP) family. Via calcitonin receptor-like receptor/receptor activity modifying proteins, the common receptor complexes of CGRP, IMD exerts a wide range of biological effects, especially regulation of cardiovascular homeostasis. Proteolytic processing of a larger IMD precursor yields a series of biologically active C-terminal fragments, IMD1-53, IMD1-47 and IMD8-47. IMD and its receptors are present in the cardiovascular system, and IMD is present at low levels in plasma. In the cardiovascular system, IMD has multiple functions such as regulation of blood pressure and cardiac function, pro-angiogenesis, endothelial barrier function protection, anti-oxidative stress, and anti-endoplasmic reticulum stress. IMD participates widely in the pathogenesis of atherosclerosis, hypertension, pulmonary arterial hypertension and vascular calcification. It is a vascular regulatory factor of homeostasis and a vital endogenous protective factor against vascular diseases.