title: Skin fluorescence correlates strongly with coronary artery calcification severity in type 1 diabetes.
abstract: BACKGROUND
  Coronary artery calcification (CAC) is more severe and occurs at an earlier age in type 1 diabetes. Risk factors for this subclinical marker of atherosclerotic burden, like coronary artery disease (CAD) itself, are not fully identified. One postulated mechanism for the increased CAC observed in type 1 diabetes is the accumulation of advanced glycation end products (AGEs). As certain collagen AGEs fluoresce, skin intrinsic fluorescence (SIF) can act as a novel marker of levels of collagen AGEs. We thus sought to determine the relationship between skin intrinsic fluorescence and CAC in type 1 diabetes.
  
  
  METHODS
  One hundred five participants in the Pittsburgh Epidemiology of Diabetes Complications study of childhood-onset (age <17 years) type 1 diabetes who had previously undergone electron beam tomography scanning for CAC (80 of whom had follow-up data) had SIF measurements taken using the SCOUT DM (VeraLight, Inc., Albuquerque, NM). Mean age and diabetes' duration were 49 and 40 years, respectively, at the time of SIF measurement.
  
  
  RESULTS
  Seventy-one percent of the study participants had some measurable CAC that was univariately (but not after age adjustment) cross-sectionally associated with SIF (odds ratio = 2.51, 1.37-4.59). However, for CAC severity using natural logarithmically transformed scores, SIF was both univariately (P < 0.0001) and multivariably (P = 0.03) associated with CAC. This relationship was independent of age, a history of CAD, renal function, or renal damage. Receiver operator characteristic analyses revealed that the discriminative ability of SIF to detect CAC went from an area under the curve of 71% for the presence of any CAC to 85% for those with a CAC score >400.
  
  
  CONCLUSIONS
  The relationship between SIF and CAC appears stronger with more severe calcification. Given the strong relationship of CAC with CAD this finding has important implications and suggests that SIF maybe a useful marker of CAC/CAD risk and potentially a therapeutic target.
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University , Nashville, Tennessee, USA.
authors.forename: Baqiyyah
authors.initials: B
authors.lastname: Conway
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Matter
authors.forename: John
authors.initials: J
authors.lastname: Maynard
authors.forename: Trevor
authors.initials: T
authors.lastname: Orchard
mesh_terms: D000328:Adult; D002114:Calcinosis / Q000473:pathology*; D003324:Coronary Artery Disease / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000473:pathology*; D005260:Female; D005453:Fluorescence; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012720:Severity of Illness Index; D012867:Skin; D013050:Spectrometry, Fluorescence
references.citation: Diabetes Care. 1990 Jul;13(7):741-7
references.pmid: 2387194
references.citation: Diab Vasc Dis Res. 2007 Dec;4(4):332-9
references.pmid: 18158704
references.citation: N Engl J Med. 2008 Mar 27;358(13):1336-45
references.pmid: 18367736
references.citation: Diabetes Care. 1994 Nov;17(11):1252-6
references.pmid: 7821163
references.citation: J Vasc Res. 2003 Nov-Dec;40(6):567-74
references.pmid: 14691339
references.citation: Diabetologia. 2009 May;52(5):789-97
references.pmid: 19274450
references.citation: Diabetes. 1990 Sep;39(9):1116-24
references.pmid: 2384191
references.citation: Diabetes Care. 2007 May;30(5):1120-4
references.pmid: 17337498
references.citation: J Am Coll Cardiol. 2000 Oct;36(4):1253-60
references.pmid: 11028480
references.citation: Radiology. 1998 Sep;208(3):807-14
references.pmid: 9722864
references.citation: Metabolism. 2006 Dec;55(12):1689-96
references.pmid: 17142145
references.citation: Diabetologia. 2009 Apr;52(4):705-14
references.pmid: 19183936
references.citation: Cell Mol Biol (Noisy-le-grand). 1998 Nov;44(7):1081-94
references.pmid: 9846890
references.citation: Diabetologia. 1983 May;24(5):347-50
references.pmid: 6873514
references.citation: J Diabetes Sci Technol. 2009 Jul 01;3(4):776-80
references.pmid: 20144328
references.citation: Biochem Biophys Res Commun. 1999 May 10;258(2):353-7
references.pmid: 10329391
references.citation: Clin Chem. 1978 Jun;24(6):900-4
references.pmid: 207462
references.citation: Mayo Clin Proc. 1999 Mar;74(3):243-52
references.pmid: 10089993
references.citation: N Engl J Med. 1991 Sep 19;325(12):836-42
references.pmid: 1875967
references.citation: Diabetologia. 2004 Jul;47(7):1324-1330
references.pmid: 15243705
references.citation: Diabetologia. 1996 Mar;39(3):298-305
references.pmid: 8721775
references.citation: Diabetes. 1999 Apr;48(4):870-80
references.pmid: 10102706
references.citation: Kidney Int. 2006 Jul;70(1):218-24
references.pmid: 16723988
references.citation: Lancet. 1994 Jun 18;343(8912):1519-22
references.pmid: 7911868
references.citation: Clin Chem. 1974 Apr;20(4):470-5
references.pmid: 4818200
references.citation: J Biol Chem. 2000 Dec 15;275(50):39027-31
references.pmid: 10976109
references.citation: Circulation. 1995 Mar 1;91(5):1363-7
references.pmid: 7867174
references.citation: AJR Am J Roentgenol. 2004 May;182(5):1327-32
references.pmid: 15100140
references.citation: Diabetes. 2000 Sep;49(9):1571-8
references.pmid: 10969842
references.citation: Br Med J (Clin Res Ed). 1982 Mar 27;284(6320):928-30
references.pmid: 6802354
references.citation: Curr Diabetes Rev. 2005 Feb;1(1):93-106
references.pmid: 18220586
references.citation: Circulation. 2000 Feb 29;101(8):850-5
references.pmid: 10694523
references.citation: Diabetes. 2003 Nov;52(11):2833-9
references.pmid: 14578303
references.citation: Opt Express. 2004 Sep 20;12(19):4496-510
references.pmid: 19484001