Diabetic Retinopathy and Skin Tissue Advanced Glycation End Products Are Biomarkers of Cardiovascular Events in Type 2 Diabetic Patients.

Alejandra Planas,Cristina Hernández,Joan Ramón Marsal,Olga Simó-Servat,Ignacio Ferreira-González,José R Herance,Rafael Simó,Ángel Ortiz-Zúñiga

doi:10.3390/jpm11121344

Abstract

Risk of cardiovascular events is not homogeneous in subjects with type 2 diabetes; therefore, its early identification remains a challenge to be met. The aim of this study is to evaluate whether the presence of diabetic retinopathy and accumulation of advanced glycation end-products in subcutaneous tissue can help identify patients at high risk of cardiovascular events. For this purpose, we conducted a prospective study (mean follow-up: 4.35 years) comprising 200 subjects with type 2 diabetes with no history of clinical cardiovascular disease and 60 non-diabetic controls matched by age and sex. The primary outcome was defined as the composite of myocardial infarction, coronary revascularization, stroke, lower limb amputation or cardiovascular death. The Cox proportional hazard multiple regression analysis was used to determine the independent predictors of cardiovascular events. The patients with type 2 diabetes had significantly more cardiovascular events than the non-diabetic subjects. Apart from the classic factors such as age, sex and coronary artery calcium score, we observed that the diabetic retinopathy and advanced glycation end-products in subcutaneous tissue were independent predictors of cardiovascular events. We conclude that the diabetic retinopathy and advanced glycation end-products in subcutaneous tissue could be useful biomarkers for selecting type 2 diabetic patients in whom the screening for cardiovascular disease should be prioritized, thereby creating more personalized and cost-effective medicine.

Highlights

Type 2 diabetes confers a substantial burden of macrovascular disease, with twoto four-fold increased risk of any cardiovascular event in comparison with non-diabetic patients [1]
We previously reported that skin autofluorescence (SAF) was a good predictor of calcium score (CACs) > 400 arbitrary units (AU), a reliable marker of coronary atherosclerosis [10]
The aim of this study is to evaluate whether the presence of diabetic retinopathy and accumulation of advanced glycation end-products (AGEs) in subcutaneous tissue can help to identify patients with type 2 diabetes at high risk of developing CV

Summary

Introduction

Type 2 diabetes confers a substantial burden of macrovascular disease, with twoto four-fold increased risk of any cardiovascular event in comparison with non-diabetic patients [1]. Type 2 diabetes is an independent risk factor for cardiovascular disease (CVD), not all patients with diabetes appear to be at equal risk. A high percentage of these patients will never experience vascular complications [2]. Early identification of diabetic patients at risk of developing CVD remains a challenge to be met [3,4]. The exaggerated risk for CVD in this population is not explained fully by conventional risk factors such obesity, hyperglycemia, dyslipidemia and hypertension, and, a substantial proportion of this risk remains unexplained [3,4]

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