Advanced glycation end products in patients with an abdominal aortic aneurysm.

Boersema, E.J. (Ellen) (2015) Advanced glycation end products in patients with an abdominal aortic aneurysm. thesis, Medicine.

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Abstract

Background and Objective Advanced glycation end products (AGEs) have been implicated in the pathogenesis of atherosclerosis and cardiovascular disease through inducement of arterial stiffness, inflammation and oxidative stress. Recently, a new method has been proposed to measure AGEs noninvasively with the AGE Reader, using skin autofluorescence (SAF). In patients with peripheral arterial occlusive disease (PAOD), SAF is increased and predicts for mortality and cardiovascular events. Patients with an abdominal aortic aneurysm (AAA) share several risk factors with PAOD patients and are at risk for cardiovascular comorbidity. We hypothesized that (1) SAF is increased in patients with AAA compared to controls without AAA or PAOD and (2) SAF is associated with mortality, occurrence of major adverse cardiovascular events (MACE) and growth, rupture or surgical repair of the aneurysm during in follow-up. Methods and Results A case-control study and follow-up study were performed. For the case-control study, 173 patients with AAA, 173 control patients with PAOD and 173 controls without AAA or PAOD were matched for age. Assessment of cardiovascular risk factors, cerebrovascular disease (CVD) and coronary artery disease (CAD) was performed. SAF was higher in AAA patients compared with controls without AAA or PAOD: geometric mean 2.76 (95% confidence interval [CI], 2.67-2.85) versus 2.54 (95% CI, 2.45-2.63), arbitrary units, P=0.003. SAF did not differ between AAA patients and controls with PAOD: geometric mean PAOD patients 2.86 (95% CI, 2.76-2.97). Independent factors for SAF in multivariate linear regression analysis of the entire study population were age, current smoking and presence of diabetes mellitus. In the follow-up study, 252 patients with AAA were included. During a median follow-up of 4.1 years (IQR 2.74 – 5.74 years) 93 patients (40%) died, of which 39 patients (16%) died of confirmed cardiovascular causes. Fatal or nonfatal MACE occurred in 56 patients (22%). In univariate Cox regression analysis, an increased SAF was not significantly associated with all-cause mortality (HR 1.12, 95% CI, 0.82-1.52), cardiovascular mortality (HR 0.97, 95% CI, 0.59-1.58) or occurrence of MACE (HR 0.87, 95% CI, 0.57-1.32). Growth, rupture or surgical repair of the AAA was investigated in a subgroup of patients without surgery for AAA before inclusion (n=93); 60 patients (65%) in this subgroup reached the combined endpoint during follow-up. In univariate Cox regression analysis, a higher SAF was not associated with a higher risk of growth, rupture or surgical repair of the AAA (HR 1.29, 95% CI, 0.91-1.83). Conclusions Tissue accumulation of AGEs, measured with SAF, is increased in patients with AAA compared with control patients without AAA or PAOD. However, AGEs accumulation does not predict for mortality, occurrence of cardiovascular events or growth, rupture or surgical repair of the aneurysm. This conceivably suggests that AGEs may play a role in the pathogenesis of dilating disease but do not to an important extent contribute to mortality.

Item Type:	Thesis (Thesis)
Supervisor name:	Lefrandt, Dr. J.D. and Smit, Prof. dr. A.J. and Vos, L.C. de
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:43
Last Modified:	25 Jun 2020 10:43
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/432

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