The clinical relevance of assessing advanced glycation endproducts accumulation in diabetes

Cardiovascular disease is the major cause of morbidity and mortality associated with diabetes. There is increasing evidence that advanced glycation endproducts (AGEs) play a pivotal role in atherosclerosis, in particular in diabetes. AGE accumulation is a measure of cumulative metabolic and oxidative stress, and may so represent the "metabolic memory". Furthermore, increased AGE accumulation is closely related to the development of cardiovascular complications in diabetes. This review article will focus on the clinical relevance of measuring AGE accumulation in diabetic patients by focusing on AGE formation, AGEs as predictors of long-term complications, and interventions against AGEs

Skin autofluorescence is increased in patients with carotid artery stenosis and peripheral artery disease

Advanced glycation end products (AGEs) have a pivotal role in atherosclerosis. We evaluated skin autofluorescence (SAF), a non-invasive measurement of tissue AGE accumulation, in patients with carotid artery stenosis with and without coexisting peripheral artery occlusive disease (PAOD). SAF was measured using the AGE Reader™ in 56 patients with carotid artery stenosis and in 56 age- and sex-matched healthy controls without diabetes, renal dysfunction or known atherosclerotic disease. SAF was higher in patients with carotid artery stenosis compared to the control group: mean 2.81 versus 2.46 (P = 0.002), but especially in the younger age group of 50–60 years old: mean 2.82 versus 1.94 (P = 0.000). Patients with carotid artery stenosis and PAOD proved to have an even higher SAF than patients with carotid artery stenosis only: mean 3.28 versus 2.66 (P = 0.003). Backward linear regression analysis showed that age, smoking, diabetes mellitus, renal function and the presence of PAOD were the determinants of SAF, but carotid artery stenosis was not. SAF is increased in patients with carotid artery stenosis and PAOD. The univariate and multivariate associations of SAF with age, smoking, diabetes, renal insufficiency and PAOD suggest that increased SAF can be seen as an indicator of widespread atherosclerosis

Skin autofluorescence and advanced glycation endproducts

Advanced glycation endproducts (AGEs) are biomarkers of metabolic stress and are thought to contribute to the increase of long-term complications in chronic age-related diseases, such as diabetes and renal failure. Until recently, all AGE-assays needed invasive sampling. However, tissue autofluorescenceis related to the accumulation of AGEs. Therefore we developed a noninvasive Autofluorescence Reader (AFR), to measure skin GE accumulation noninvasively. The aims of this thesis were to validate the AFR as a measure of AGE accumulation, to evaluate skin autofluorescence as a clinical tool and its relationship with long-term complications in diabetes and renal failure. Zie: Summary

Carotid artery stenting:a 2009 update

Purpose of review Carotid endarterectomy (CEA) is is still considered the gold standard in the treatment of patients with significant carotid stenosis and has proven its value over the past decades. Endovascular techniques have evolved, and carotid artery stenting (CAS) is challenging CEA to become the better treatment. Various trends were noted throughout the past decade with shifts against and pro CAS The aim of this review is to describe the most important findings related to CAS, published in the last 1.5 years, in order to present its current status. Recent findings A total of 12 randomized trials have been initiated at this moment. The long-term results of both the Stent-Protected Angioplasty versus Carotid Endarterectomy and Endarterectomy versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis trials were published last year. Last month, primary safety data from the International Carotid Stenting Study trial were also presented All these three trials failed to show superiority of CAS. Results favored CEA mainly because of periprocedural complications with CAS Summary It is anticipated that whenever eligible for CEA, patients should be scheduled to undergo surgery, reserving CAS for high-risk patients and patients with anatomical restrictions. Most likely, evolving best medical treatment, timely intervention and analysis of plaque composition will have an important influence on the future treatment of carotid artery stenosis, regardless of the treatment option chosen