Advanced glycation end products in patients with peripheral artery disease

Peripheral artery disease (PAD) is a disease in which stenosis or occlusion occurs of the arteries of the lower limbs. The most common underlying disease is atherosclerosis. The main presenting symptom of these patients is intermittent claudication, which is typical leg pain during walking that disappears during rest. Patients with progressed disease may suffer from rest pain, ulcers and are at risk for amputation. An estimated prevalence of the patients suffering from PAD is 200 million, which is an increase of more than 23% within a decade. Besides intermittent claudication and risk of amputation, these patients are at risk for development of other cardiovascular disease and death.

Advanced glycation end products (AGEs) are known to play an important role in atherosclerosis. However, the role of AGEs in patients with peripheral artery disease is unknown. This thesis contributes to this knowledge gap.

Assessment of AGEs can be performed noninvasively with the use of the AGE Reader. The AGE Reader emits ultraviolet light on a small surface of the skin of the forearm. Due to fluorescent properties of several AGEs, skin AGE accumulation can be estimated.

A total of 500 patients were included for several studies and they were followed for five years. Patients with PAD have increased skin AGEs compared to controls. Furthermore, skin AGEs were able to detect high risk patients for a myocardial infarction, stroke, amputation or death. This thesis underscores the important role of AGEs in patients with PAD and identifies patient at highest risk for cardiovascular disease.