Ethnicity and skin autofluorescence-based risk-engines for cardiovascular disease and diabetes mellitus

<div><p>Skin auto fluorescence (SAF) is used as a proxy for the accumulation of advanced glycation end products (AGEs) and has been proposed to stratify patients into cardiovascular disease (CVD) and diabetes mellitus (DM) risk groups. This study evaluates the effects of seven different ethnicities (Arab, Central-East African, Eastern Mediterranean, European, North African, South Asian and Southeast Asian) and gender on SAF as well as validating SAF assessment as a risk estimation tool for CVD and DM in an Arabian cohort. SAF data from self-reported healthy 2,780 individuals, collated from three independent studies, has been linear modelled using age and gender as a covariate. A cross-study harmonized effect size (Cohens’<i>d</i>) is provided for each ethnicity. Furthermore, new data has been collected from a clinically well-defined patient group of 235 individuals, to evaluate SAF as a clinical tool for DM and CVD-risk estimation in an Arab cohort. In an Arab population, SAF-based CVD and/or DM risk-estimation can be improved by referencing to ethnicity and gender-specific SAF values. Highest SAF values were observed for the North African population, followed by East Mediterranean, Arab, South Asian and European populations. The South Asian population had a slightly steeper slope in SAF values with age compared to other ethnic groups. All ethnic groups except Europeans showed a significant gender effect. When compared with a European group, effect size was highest for Eastern Mediterranean group and lowest for South Asian group. The Central-East African and Southeast Asian ethnicity matched closest to the Arab and Eastern Mediterranean ethnicities, respectively. Ethnic and gender-specific data improves performance in SAF-based CVD and DM risk estimation. The provided harmonized effect size allows a direct comparison of SAF in different ethnicities. For the first time, gender differences in SAF are described for North African and East Mediterranean populations.</p></div

SAF model comparison for different ethnic groups.

<p>SAF model comparison for different ethnic groups.</p

Skin Autofluorescence Datasets

Skin Autofuorescence (SAF) measurements of a healthy population (n=2,780) and of individuals with Cardiovascular Disease (CVD, n=50), Diabetes (DM, n=111) and mixed disease phenotypes (n=74)

Ethnicities and sample numbers for all study participants (upper panel); geographic stratification for subsequent statistical analysis (lower panel).

<p>Ethnicities and sample numbers for all study participants (upper panel); geographic stratification for subsequent statistical analysis (lower panel).</p

Comparison of SAF intensities between healthy individuals and CVD patients with and without diabetes in an Arab cohort.

<p>Insets show the distribution of risk groups as calculated with the established risk engine that is implemented in the AGE-Reader apparatus and the adjusted risk scheme for Middle Eastern populations, both described in Ahmad <i>et al</i>. [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185175#pone.0185175.ref013" target="_blank">13</a>].</p