Advanced glycation end products, leukocyte telomere length, and mitochondrial DNA copy number in patients with coronary artery disease and alterations of glucose homeostasis: From the GENOCOR study

Background and aim: Alterations of glucose homeostasis can increase advanced glycation end products (AGEs) that exacerbate vascular inflammatory disease and may increase vascular senescence and aging. This study examined the relationships between carboxymethyl-lysine (CML) and soluble receptor for AGEs (sRAGE) with leukocyte telomere length (LTL) and mitochondrial DNA copy number (mtDNAcn), as cell aging biomarkers, in patients with established coronary artery disease (CAD). Methods and results: We studied 459 patients with CAD further categorized as having normal glucose homeostasis (NG, n Z 253), pre-diabetes (preT2D, n Z 85), or diabetes (T2D, n Z121). All patients were followed up for the occurrence of major adverse cardiovascular events (MACEs). Plasma concentrations of sRAGE and CML were measured by ELISA. mtDNAcn and LTL weremeasuredbyqRT-PCR.CMLlevelsweresignificantly higher inpatients with preT2D (p <0.007) or T2D (p <0.003) compared with those with NG. mtDNAcn resulted lower inT2D vs preT2D (p Z 0.04). At multivariate Cox proportional hazard analysis, short LTL (HR: 2.89; 95% CI: 1.11e10.1; p Z 0.04) and high levels of sRAGE (HR: 2.20; 95% CI: 1.01e5.14; p Z 0.04) were associated with an increased risk for MACEs in patients with preT2D and T2D, respectively. T2D patients with both short LTL and high sRAGE levels had the highest risk of MACEs (HR: 3.11; 95% CI: 1.11e9.92; p Z 0.04). Conclusions: High levels of sRAGE and short LTL were associated with an increased risk of MACEs, especially in patients with diabetes, supporting the usefulness of both biomarkers of glycemic impairment and aging in predicting cardiovascular outcomes in patients with CAD.