Determination of advanced glycation end products in patients with stable coronary heart disease as a part of a comprehensive assessment of residual cardiovascular risk

Introduction. Patients with coronary artery disease (CAD) have a residual risk of adverse vascular events. The multifactorial and heterogeneous nature of this risk requires an integrative approach to assessment, which is a pressing issue in cardiology. The role of lipoprotein (a) (Lp(a)) as a marker of residual risk has been demonstrated. In this article the role of advanced glycation end products (AGEs) is being investigated in the progression of residual risk in patients with CAD.

Aim: To evaluate the relationship between the autofluorescence index of advanced glycation end products and lipoprotein (a) levels to determine residual risk in patients with stable coronary artery disease and dyslipidemia receiving intensive lipid-lowering therapy.

Materials and Methods: A single-center prospective study was conducted involving 87 men aged 55 to 75 years with CAD and comorbidities. Standard laboratory tests, including Lp(a) levels, and instrumental methods in accordance with clinical guidelines were used. AGEs accumulation was also determined by calculating the autofluorescence index using the portable AGE Reader device. Dyslipidemia was corrected with a fixed combination of rosuvastatin and ezetimibe; alirocumab when indicated. The median follow-up was 12 weeks. Statistical processing was performed using StatTech 4.9.4 (StatTech LLC, Russia).

Results. Study participants were divided into subgroups based on Lp(a) levels >0.5 g/L (n = 41) and <0.5 g/L (n = 46) assessing residual risk. Lipid profile target parameters were achieved in 78.2% of patients (n = 68) with the fixed-dose combination of rosuvastatin and ezetimibe and in 21,8% (n = 19) with triple therapy, of which 17.2% (n = 15) belonged to subgroup 1 and 4.6% (n = 4) to subgroup 2. Autofluorescence index at baseline: 2.8 [2.20; 4.07]. After 6 weeks of intensive lipid-lowering therapy and adequate treatment of comorbid pathology, the autofluorescence index was 2.79 [2.12; 4.00]; after 12 weeks – 2.75 [2.02; 3.88]. According to the color identification of the device, the red autofluorescence index (very high risk) was observed in 54% of patients at the start of the study (n = 47), and after 12 weeks – in 35.6% (n = 31). The study showed a strong direct correlation with the level of AGEs at the start and after 12 weeks for the group with the Lp(a)>0.5 g/l. ROC analysis demonstrated that an increase in the autofluorescence index is a statistically significant predictor of increased residual risk (AUC = 0.976; 95% CI: 0.918–1.000, p < 0.001). The sensitivity and specificity of the predictive model were estimated at 93.3%.

Conclusions: The AGEs autofluorescence index may be used for comprehensive noninvasive assessment of residual risk in patients with stable coronary artery disease and hyperlipoproteinemia (a).

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