Association between the tissue accumulation of advanced glycation end products and exercise capacity in cardiac rehabilitation patients

Mitsuhiro Kunimoto, Kazunori Shimada*, Miho Yokoyama, Tomomi Matsubara, Tatsuro Aikawa, Shohei Ouchi, Megumi Shimizu, Kosuke Fukao, Tetsuro Miyazaki, Tomoyasu Kadoguchi, Kei Fujiwara, Abidan Abulimiti, Akio Honzawa, Miki Yamada, Akie Shimada, Taira Yamamoto, Tohru Asai, Atsushi Amano, Andries J. Smit, Hiroyuki Daida

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background Advanced glycation end products (AGEs) are associated with aging, diabetes mellitus (DM), and other chronic diseases. Recently, the accumulation of AGEs can be evaluated by skin autofluorescence (SAF). However, the relationship between SAF levels and exercise capacity in patients with cardiovascular disease (CVD) remains unclear. This study aimed to investigate the association between the tissue accumulation of AGEs and clinical characteristics, including exercise capacity, in patients with CVD. Methods We enrolled 319 consecutive CVD patients aged >= 40 years who underwent early phase II cardiac rehabilitation (CR) at our university hospital between November 2015 and September 2017. Patient background, clinical data, and the accumulation of AGEs assessed by SAF were recorded at the beginning of CR. Characteristics were compared between two patient groups divided according to the median SAF level (High SAF and Low SAF). Results The High SAF group was significantly older and exhibited a higher prevalence of DM than the Low SAF group. The sex ratio did not differ between the two groups. AGE levels showed significant negative correlations with peak oxygen uptake and ventilator efficiency (both P <0.0001). Exercise capacity was significantly lower in the high SAF group than in the low SAF group, regardless of the presence or absence of DM (P <0.05). A multivariate logistic regression analysis showed that SAF level was an independent factor associated with reduced exercise capacity (odds ratio 2.10; 95% confidence interval 1.13-4.05; P = 0.02). Conclusion High levels of tissue accumulated AGEs, as assessed by SAF, were significantly and independently associated with reduced exercise capacity. These data suggest that measuring the tissue accumulation of AGEs may be useful in patients who have undergone CR, irrespective of whether they have DM.

Original languageEnglish
Article number195
Number of pages9
JournalBMC Cardiovascular Disorders
Issue number1
Publication statusPublished - 23-Apr-2020


  • Advanced glycation end products
  • Exercise tolerance
  • Cardiac rehabilitation
  • Skin autofluorescence


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