Plasma Carboxymethyl-Lysine, an Advanced Glycation End Product, and All-Cause and Cardiovascular Disease Mortality in Older Community-Dwelling Adults

OBJECTIVES: To determine whether older adults with high plasma carboxymethyl-lysine (CML), an advanced glycation end product, are at higher risk of all-cause and cardiovascular disease (CVD) mortality.
DESIGN: Prospective cohort study.
SETTING: Population-based sample of adults aged 65 and older residing in Tuscany, Italy.
PARTICIPANTS: One thousand thirteen adults participating in the Invecchiare in Chianti study.
MEASUREMENTS: Anthropometric measures, plasma CML, fasting plasma total, high-density and low-density lipoprotein cholesterol, triglycerides, glucose, creatinine. Clinical measures: medical assessment, diabetes mellitus, hypertension, coronary heart disease, heart failure, stroke, cancer. Vital status measures: death certificates and causes of death according to the International Classification of Diseases . Survival methods were used to examine the relationship between plasma CML and all-cause and CVD mortality, adjusting for potential confounders.
RESULTS: During 6 years of follow-up, 227 (22.4%) adults died, of whom 105 died with CVD. Adults with plasma CML in the highest tertile had greater all-cause (hazard ratio (HR)=1.84, 95% confidence interval) CI)=1.30–2.60, P <.001) and CVD (HR=2.11, 95% CI=1.27–3.49, P =.003) mortality than those in the lower two tertiles after adjusting for potential confounders. In adults without diabetes mellitus, those with plasma CML in the highest tertile had greater all-cause (HR=1.68, 95% CI=1.15–2.44, P =.006) and CVD (HR=1.74, 95% CI=1.00–3.01, P =.05) mortality than those in the lower two tertiles after adjusting for potential confounders.
CONCLUSION: Older adults with high plasma CML are at higher risk of all-cause and CVD mortality.