Advanced glycation endproducts and dicarbonyl compounds are not associated with coronary atherosclerosis characteristics in middle-aged and older male athletes
Authors: Aengevaeren V L , Berge K , Mosterd A , Velthuis B , Lyngbakken M N , Omland T , Schalkwijk C , Eijsvogels T M H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation.

Background
Cardiovascular disease is the leading cause of mortality worldwide and is dominated by coronary atherosclerosis. Moreover, coronary atherosclerosis is the most common cause of sudden cardiac death among athletes and current screening methods lack sufficient accuracy for identifying individuals at high risk. Advanced glycemic end products (AGEs) and dicarbonyl stress markers are generated during normal metabolism and aging, but increase in the presence of hyperglycemia, oxidative stress and inflammation. Several studies have demonstrated that higher concentrations of AGEs in plasma predict both the presence and severity of coronary atherosclerosis, as well as mortality. AGEs and its dicarbonyl precursors in atherosclerotic plaques have also been demonstrated to predict rupture-prone phenotypes. Plasma AGEs and dicarbonyl precursors might be a novel way to screen for high-risk coronary atherosclerosis in middle-aged and older athletes.

Purpose
To assess the association between plasma AGEs and dicarbonyl compounds with the presence of coronary plaques, plaque characteristics and coronary artery calcification scores in a population of middle-aged and older amateur athletes.

Methods
We measured concentrations of AGEs and dicarbonyl stress markers in plasma with dilution ultra-performance liquid chromatography tandem mass spectrometry in middle-aged and older athletes from the Measuring Athletes’ Risk of Cardiovascular Events (MARC) 2 study cohort. Coronary plaques, predominating plaque characteristics (&gt;50% calcified, non-calcified, or mixed plaque composition), and coronary artery calcification scores were assessed using coronary computed tomography. We explored associations with linear and logistic regression analyses and compared groups with the Mann-Whitney U and Kruskal-Wallis tests, while correcting for multiple testing.

Results
284 men were included with a median age of 60 [56-66] years, body mass index of 24.5 [22.9-26.7] kg/m2, and an average weekly exercise volume of 41 [26-57] Metabolic Equivalent of Task-hours. Coronary plaques were detected in 241 participants (83%), with calcified, non-calcified, and mixed plaques constituting &gt;50% of plaques in 42%, 12%, and 21%, respectively. Median CAC score was 31 [0-132]. None of the AGEs or dicarbonyl stress markers were associated with presence of plaques, any of the plaque characteristics (Figure 1), or coronary artery calcification score categories (Figure 2) in adjusted analyses (P&gt;0.05).

Conclusion
Concentrations of AGEs and dicarbonyl stress markers could not be used to identify coronary plaques, different plaque characteristics or coronary calcifications in this cohort of middle-aged and older athletes. These findings suggest that AGEs and dicarbonyl stress markers cannot be used as a screening method for high-risk coronary atherosclerosis.