title: The receptor for advanced glycation end products and risk of peripheral arterial disease, amputation or death in type 2 diabetes: a population-based cohort study.
abstract: BACKGROUND
  Patients with type 2 diabetes have a high risk for early and extensive development of peripheral arterial disease (PAD) and this excess risk is not explained by increased burden of traditional atherosclerotic risk factors. Activation of the receptor for advanced glycation end products (RAGE) could be one additional mechanism for accelerated PAD and increased risk for amputation and death. We investigated the association between RAGE plasma components and the risk for PAD, amputation and death in patients with type 2 diabetes. We also estimated the rate of amputation-free survival and survival without PAD.
  
  
  METHODS
  We investigated if plasma levels of carboxymethyl-lysine, S100A12 and endosecretory RAGE (esRAGE) were associated with two endpoints: survival without development of PAD and survival without amputation in a 12 years prospective population-based cohort of 146 patients with type 2 diabetes, free from PAD at inclusion. Influence of baseline plasma levels of RAGE ligands (individually and combined by a RAGE-score) were evaluated for both endpoints in the Cox-regression analysis.
  
  
  RESULTS
  106 patients survived without amputation and 93 survived without signs of PAD during follow up. Higher levels of S100A12 and RAGE-score were associated with increased risk for amputation or death, hazard ratios (HR) 1.29; 95% confidence interval (CI) [1.04, 1.59] and 1.79; 95% CI [1.07, 2.99] and with increased risk for PAD or death, HR 1.22; 95% CI [1.00, 1.49] and 1.56; [1.00, 2.44] after adjustment for age and sex. The effect was decreased after adjustment for Framingham cardiovascular disease score: risk for amputation or death, HR 1.17; 95% CI [0.94, 1.46] and 1.54; [0.95, 2.49], and risk for PAD or death, HR 1.12; 95% CI [0.91, 1.38] and 1.38; [0.91, 2.11] for S100A12 and RAGE-score respectively. The incidence for amputation or death was 2.8 per 100 person-years; 95% CI [2.0, 3.7] and the incidence rate for PAD or death was 3.6 per 100 person-years; 95% CI [2.7, 4.8].
  
  
  CONCLUSIONS
  Higher plasma levels of S100A12 and the combined effect (RAGE-score) of esRAGE, carboxymethyl-lysine and S100A12 seem to be associated with shorter PAD- and amputation-free survival in patients with type 2 diabetes. This may indicate a role for S100A12 in PAD by activation of the RAGE system.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. jonas.malmstedt@sodersjukhuset.se.|Division of Vascular Surgery, Department of Surgery, South Hospital, 118 83, Stockholm, Sweden. jonas.malmstedt@sodersjukhuset.se.
authors.forename: Jonas
authors.initials: J
authors.lastname: Malmstedt
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. lars.karvestedt@stockholmssjukhem.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Kärvestedt
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. jesper.swedenborg@ki.se.
authors.forename: Jesper
authors.initials: J
authors.lastname: Swedenborg
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. kerstin.brismar@ki.se.|Karolinska University Hospital, Stockholm, Sweden. kerstin.brismar@ki.se.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Brismar
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D015415:Biomarkers / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003925:Diabetic Angiopathies / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008239:Lysine / Q000031:analogs & derivatives / Q000097:blood; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016016:Proportional Hazards Models; D000067759:Receptor for Advanced Glycation End Products / Q000097:blood*; D018570:Risk Assessment; D012307:Risk Factors; D000067616:S100A12 Protein / Q000097:blood; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors
chemical_list: C000593871:AGER protein, human; D015415:Biomarkers; D000067759:Receptor for Advanced Glycation End Products; D000067616:S100A12 Protein; C090441:S100A12 protein, human; C048496:N(6)-carboxymethyllysine; D008239:Lysine