P 16: Role of short-term and advanced glycation end products in arterial stiffness in diabetes and prediabetes

Abstract

Advanced Glycated Endproducts (AGEs) can be estimated by measuring cutaneous autofluorescence (AF). AGEs are increased in type 1 diabetic patients and have been shown to predict cardiovascular disease. Arterial stiffness is a cardiovascular risk integrator, and experimental data suggest that AGEs may play a role in arterial ageing and stiffness. Our objective was to examine the relationship between AGEs, HbA1c and arterial stiffness in type 2 diabetes and prediabetes. Since april 2012 we have included 68 patients with a mean age of 50.8±13.5 years and a mean BMI of 39.6±6.7 kg/m2. Twenty-eight patients had known or oral glucose tolerance test (OGTT)-detected diabetes. Based on OGTT 32 obese patients were normoglycemic (NGT) and 8 glucose intolerant (IGT). AF was measured with the AGE Reader® device, and arterial stiffness was evaluated by applanation tonometry (SphygmoCor®) measurement of carotid to femoral Pulse Wave Velocity (PWV), and the amplification index was measured using the same device and corrected for a heart rate of 75 beats/minute (AIx75). Diabetic patients were older and had higher HbA1c than non diabetics but PWV and AIx75 did not differ significantly between the two groups. In the overall series PWV did not correlate with HbA1c (p=0.171) whereas AF correlated with age (R2=0.404, p<0.0001) and PWV (R2=0.162; p<0.001). In the diabetic patients AF remained a significant predictor for PWV (1 m/sec increase in PWV for an AF increase of 2.2 units, p=0.018) after adjustment for age, systolic blood pressure and HbA1c. In the non diabetic patients including the NGTs/IGTs, HbA1c (p=0.033) was a significant predictor for PWV (1 m/sec increase in PWV for an HbA1c increase of 2.8%) adjusted for the above mentioned variables. The AIx75 did not correlate with HbA1c or AF in both groups. In obese non diabetic patients short-term glycation products (represented herein by HbA1c) participate in arterial stiffness while in diabetic patients the long-term accumulation of advanced glycation end products is associated with an increase in arterial stiffness. The present data suggest that glycaemia and the subsequent glycation process contributes to arterial stiffening even before overt diabetes. Larger scale studies are needed to confirm these results.