Higher Plasma Methylglyoxal Levels Are Associated With Incident Cardiovascular Disease and Mortality in Individuals With Type 2 Diabetes

• DOI: 10.2337/dc18-0159
• Publication Date: 2018-05-21T13:25:12Z
• Authors: Nordin M.J. Hanssen; Jan Westerink; Jean L.J.M. Scheijen; Yolanda van der G...; Coen D.A. Stehouwer; Casper G. Schalkwijk; ; Ale Algra; Yolanda van der G...; Rick D.E. Grobbee; Guy E.H.M. Rutten; Frank L.J. Visseren; Gert Jan de Borst; Jaap L.J. Kappelle; Tim Leiner; Hendrik M. Nathoe
• Keywords: Adult; Male; 0301 basic medicine; Endocrinology, Diabetes and Metabolism; Myocardial Infarction; EVENTS; Cohort Studies; 03 medical and health sciences; Risk Factors; Internal Medicine; Humans; COHORT; Advanced and Specialised Nursing; EPIC-NL; Mortality; Aged; Incidence; Middle Aged; Pyruvaldehyde; Survival Analysis; 3. Good health; MICE; Diabetes Mellitus, Type 2; Cardiovascular Diseases; Female; GLYCATION END-PRODUCTS; FOLLOW-UP; Diabetic Angiopathies

OBJECTIVE Methylglyoxal (MGO) is a reactive dicarbonyl compound and a potential key player in diabetic cardiovascular disease (CVD). Whether plasma MGO levels are associated with CVD in type 2 diabetes is unknown.

RESEARCH DESIGN AND METHODS We included 1,003 individuals (mean ± SD age 59.1 ± 10.5 years, 69.3% male, and 61.6% with prior CVD) with type 2 diabetes from the Second Manifestations of ARTerial disease cohort (SMART). We measured plasma MGO levels and two other dicarbonyls (glyoxal [GO] and 3-deoxyglucosone [3-DG]) at baseline with mass spectrometry. Median follow-up of CVD events was 8.6 years. Data were analyzed with Cox regression with adjustment for sex, age, smoking, systolic blood pressure, total cholesterol, HbA1c, BMI, prior CVD, and medication use. Hazard ratios are expressed per SD Ln-transformed dicarbonyl.

RESULTS A total of 287 individuals suffered from at least one CVD event (n = 194 fatal events, n = 146 myocardial infarctions, and n = 72 strokes); 346 individuals died, and 60 individuals underwent an amputation. Higher MGO levels were associated with total (hazard ratio 1.26 [95% CI 1.11–1.42]) and fatal (1.49 [1.30–1.71]) CVD and with all-cause mortality (1.25 [1.11–1.40]), myocardial infarction (1.22 [1.02–1.45]), and amputations (1.36 [1.05–1.76]). MGO levels were not apparently associated with stroke (1.03 [0.79–1.35]). Higher GO levels were significantly associated with fatal CVD (1.17 [1.00–1.37]) but not with other outcomes. 3-DG was not significantly associated with any of the outcomes.

CONCLUSIONS Plasma MGO and GO levels are associated with cardiovascular mortality in individuals with type 2 diabetes. Influencing dicaronyl levels may therefore be a target to reduce CVD in type 2 diabetes.