Abstract
BackgroundAdvanced glycation end-products play a role in diabetic vascular complications. Their optical properties allow to estimate their accumulation in tissues by measuring the skin autofluorescence (SAF). We searched for an association between SAF and major adverse cardiovascular events (MACE) incidence in subjects with Type 1 Diabetes (T1D) during a 7 year follow-up.MethodsDuring year 2009, 232 subjects with T1D were included. SAF measurement, clinical [age, sex, body mass index (BMI), comorbidities] and biological data (HbA1C, blood lipids, renal parameters) were recorded. MACE (myocardial infarction, stroke, lower extremity amputation or a revascularization procedure) were registered at visits in the center or by phone call to general practitioners until 2016.ResultsThe participants were mainly men (59.5%), 51.5 ± 16.7 years old, with BMI 25.0 ± 4.1 kg/m2, diabetes duration 21.5 ± 13.6 years, HbA1C 7.6 ± 1.1%. LDL cholesterol was 1.04 ± 0.29 g/L, estimated Glomerular Filtration Rates (CKD-EPI): 86.3 ± 26.6 ml/min/1.73 m2. Among these subjects, 25.1% were smokers, 45.3% had arterial hypertension, 15.9% had elevated AER (≥ 30 mg/24 h), and 9.9% subjects had a history of previous MACE. From 2009 to 2016, 22 patients had at least one new MACE: 6 myocardial infarctions, 1 lower limb amputation, 15 revascularization procedures. Their SAF was 2.63 ± 0.73 arbitrary units (AU) vs 2.08 ± 0.54 for other patients (p = 0.002). Using Cox-model, after adjustment for age (as the scale time), sex, diabetes duration, BMI, hypertension, smoking status, albumin excretion rates, statin treatment and a previous history of MACE, higher baseline levels of SAF were significantly associated with an increased risk of MACE during follow-up (HR = 4.13 [1.30–13.07]; p = 0.02 for 1 AU of SAF) and Kaplan–Meier curve follow-up showed significantly more frequent MACE in group with SAF upper the median (p = 0.001).ConclusionA high SAF predicts MACE in patients with T1D.
Highlights
Despite the decline of cardiovascular disease in patients with type 1 diabetes (T1D) [1], it remains by far the first cause of mortality, as recently reported in patients with long duration of diabetes [2], and a major concern even in children who often present features of subclinicalLong-term hyperglycaemia promotes cardiovascular mortality, with a gradual increase of hazard ratios for death among patients with Type 1 Diabetes (T1D) compared to non diabetic subjects according to the HbA1C levels [6]
The following data were recorded at inclusion on the day of skin autofluorescence (SAF) measurement: age, sex, body mass index, duration of diabetes, treatment by Continuous Subcutaneous Insulin Infusion, arterial hypertension, treatment by statins, previous macrovascular events, and smoking history
The scatterplot for SAF over age is presented as a Additional file 1: Figure S1
Summary
Despite the decline of cardiovascular disease in patients with type 1 diabetes (T1D) [1], it remains by far the first cause of mortality, as recently reported in patients with long duration of diabetes [2], and a major concern even in children who often present features of subclinicalLong-term hyperglycaemia promotes cardiovascular mortality, with a gradual increase of hazard ratios for death among patients with T1D compared to non diabetic subjects according to the HbA1C levels [6]. Advanced glycation end-products (AGEs) generated from excess glucose have deleterious effects on endothelial cells [9] They are thought to contribute to the memory of hyperglycaemia [10]. The skin concentrations of AGEs have been related to the progression of intimamedia thickness in the DCCT-EDIC study [11] Due to their fluorescent properties, the accumulation of AGEs in tissues can be estimated by measuring the skin autofluorescence (SAF) [12]. Advanced glycation end-products play a role in diabetic vascular complications Their optical proper‐ ties allow to estimate their accumulation in tissues by measuring the skin autofluorescence (SAF). We searched for an association between SAF and major adverse cardiovascular events (MACE) incidence in subjects with Type 1 Diabetes (T1D) during a 7 year follow-up
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