ABSTRACT
OBJECTIVE: Evidence for an important role of advanced glycation end products (AGEs) in the development of atherosclerosis and cardiovascular disease beyond diabetes mellitus and renal disease is growing. Skin autofluorescence (SAF) is a validated noninvasive measure of tissue AGEs. We hypothesized that SAF is elevated in peripheral artery disease (PAD). METHODS AND RESULTS: A case-control study was performed in 492 patients with PAD and 164 controls, matched for age (mean 66 ± 10 years) and presence of diabetes mellitus. Cardiovascular risk factors and comorbidity (coronary artery disease, cerebrovascular disease, abdominal aortic aneurysm) were assessed. SAF was measured with the AGE Reader. SAF was higher in patients compared with controls: geometric mean 2.77 (95% confidence interval [CI], 2.71-2.83) versus 2.44 (95% CI, 2.35-2.53) arbitrary units, P=0.4×10(-8). In logistic regression, the adjusted odds ratio for the presence of PAD was 2.47 (95% CI, 1.66-3.69) per 1 unit increase of SAF. PAD patients with cardiovascular comorbidity had a higher SAF compared with those without: geometric mean 2.93 (95% CI, 2.85-3.02) versus 2.63 (95% CI, 2.55-2.71) arbitrary units, P=0.4×10(-6), also after correction for confounders. Regression analysis showed that age, smoking, diabetes mellitus, chronic kidney disease, and a history of cerebrovascular disease or abdominal aortic aneurysm were independently associated with SAF in the patients with PAD. CONCLUSIONS: Accumulation of tissue AGEs is increased in patients with PAD, independent of cardiovascular risk factors and comorbidity, although these conditions are associated with a further increase. These findings underscore the importance of AGEs in PAD, irrespective of the presence of diabetes mellitus and renal insufficiency.
Subject(s)
Glycation End Products, Advanced/metabolism , Optical Imaging , Peripheral Arterial Disease/metabolism , Skin Absorption , Skin/metabolism , Age Factors , Aged , Case-Control Studies , Chi-Square Distribution , Comorbidity , Female , Humans , Linear Models , Logistic Models , Male , Middle Aged , Netherlands/epidemiology , Odds Ratio , Optical Imaging/methods , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Predictive Value of Tests , Risk Assessment , Risk Factors , Smoking/adverse effects , Smoking/epidemiology , Spectrometry, Fluorescence , Up-RegulationABSTRACT
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.
Subject(s)
Carotid Stenosis/metabolism , Glycation End Products, Advanced/analysis , Peripheral Arterial Disease/metabolism , Skin/chemistry , Age Factors , Aged , Biomarkers/analysis , Carotid Stenosis/complications , Carotid Stenosis/diagnostic imaging , Case-Control Studies , Female , Humans , Linear Models , Male , Middle Aged , Multivariate Analysis , Netherlands , Peripheral Arterial Disease/complications , Risk Assessment , Risk Factors , Spectrometry, Fluorescence , Ultrasonography, Doppler, Duplex , Up-RegulationABSTRACT
The authors describe the possibilities and advantages of ruby laser treatment of large congenital nevi as an alternative to surgical excision. The literature (from 1980 to 2002) is reviewed and a case report is presented. Literature and the authors' experience show good cosmetic results after ruby laser treatment. Skin texture is improved and there is a considerable reduction in pigmentation and unsightly hair growth. Ruby laser treatment does not result in scarring, mutilation, or functional impairments, in contrast to surgical treatment. Only short outpatient sessions are required, recovery periods are extremely short, and no rehabilitation period is needed. No malignant changes have been reported after treatment with the ruby laser, even after 8 years of follow-up. The results imply that ruby laser treatment could be a valuable new treatment modality for large congenital nevi. It should be considered when patients refuse to undergo surgery, or when surgery would cause severe morbidity. More research should be initiated to assess possible risks and long-term results.