Serum advanced glycation endproducts are associated with left ventricular dysfunction in normal glucose metabolism but not in type 2 diabetes: The Hoorn Study

Objective: To investigate whether serum advanced glycation endproducts are associated with left ventricular systolic and diastolic function in participants with normal glucose metabolism, impaired glucose metabolism and type 2 diabetes mellitus. Methods: Participants from a cross-sectional, population-based study (n=280 with normal glucose metabolism, n=171 with impaired glucose metabolism, n=242 with type 2 diabetes mellitus) underwent echocardiography. Serum protein-bound advanced glycation endproducts [i.e. N epsilon-(carboxymethyl)lysine, pentosidine and N epsilon-(carboxyethyl)lysine] were measured. Linear regression analyses were used and stratified according to glucose metabolism status. Results: In normal glucose metabolism, higher N epsilon-(carboxymethyl)lysine and pentosidine levels were associated with worse diastolic function (left atrial volume index and left atrial volumexleft ventricular mass index product term) and higher N epsilon-(carboxymethyl)lysine and N epsilon-(carboxyethyl)lysine levels with worse systolic function (ejection fraction). In impaired glucose metabolism, a similar pattern emerged, though less consistent. In type 2 diabetes mellitus, these associations were non-existent for diastolic function or even reversed for systolic function. Conclusion: This suggests that serum advanced glycation endproducts are associated with impaired left ventricular function in normal glucose metabolism, but that with deteriorating glucose metabolism status, serum advanced glycation endproducts may not mirror heart failure risk.