Kathryn H Williams1, David R Sullivan2, Geoffrey C Nicholson3, Jacob George4, Alicia J Jenkins5, Andrzej S Januszewski5, Val J Gebski5, Patrick Manning6, Yong Mong Tan7, Mark W Donoghoe5, Christian Ehnholm8, Simon Young9, Richard O'Brien10, Luke Buizen5, Stephen M Twigg11, Anthony C Keech12. 1. Sydney Medical School, University of Sydney, Sydney NSW, Australia; Royal Prince Alfred Hospital, Sydney NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney NSW, Australia. 2. Royal Prince Alfred Hospital, Sydney NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney NSW, Australia. 3. Rural Clinical School, University of Queensland, Brisbane QLD, Australia. 4. Sydney Medical School, University of Sydney, Sydney NSW, Australia; Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, Sydney NSW, Australia. 5. National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney NSW, Australia. 6. Department of Medical and Surgical Sciences, Dunedin School of Medicine, Dunedin, New Zealand. 7. Townsville Diabetes and Endocrine Unit, Townsville Hospital, Townsville QLD, Australia. 8. Biomedicum Helsinki, Helsinki, Finland. 9. Diabetes Clinic, Northshore Hospital, Auckland, New Zealand. 10. Austin hospital, Melbourne VIC, Australia. 11. Sydney Medical School, University of Sydney, Sydney NSW, Australia; Royal Prince Alfred Hospital, Sydney NSW, Australia. 12. Royal Prince Alfred Hospital, Sydney NSW, Australia; National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney NSW, Australia. Electronic address: fieldtrial@ctc.usyd.edu.au.
Abstract
AIMS: Reported associations between liver enzymes and mortality may not hold true in type 2 diabetes, owing to a high prevalence of non-alcoholic fatty liver disease, which has been linked to cardiovascular disease and mortality in its own right. Our study aimed to determine whether alanine aminotransferase (ALT) or γ-glutamyl transferase (GGT) levels predict mortality in type 2 diabetes, and to examine possible mechanisms. METHODS: Data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were analyzed to examine the relationship between liver enzymes and all-cause and cause-specific mortality over 5years. RESULTS: Over 5years, 679 (6.9%) individuals died. After adjustment, for every standard deviation increase in ALT (13.2U/L), the HR for death on study was 0.85 (95% CI 0.78-0.93), p<0.001. Conversely, GGT >70U/L, compared with GGT ≤70U/L, had HR 1.82 (1.48-2.24), p<0.001. For cause-specific mortality, lower ALT was associated with a higher risk of cardiovascular death only, whereas GGT >70U/L was associated with higher risks of death due to cardiovascular disease, cancer and non-cancer/non-cardiovascular causes. The relationship for ALT persisted after adjustment for indirect measures of frailty but was attenuated by elevated hsCRP. CONCLUSIONS: As in the general population, ALT has a negative, and GGT a positive, correlation with mortality in type 2 diabetes when ALT is less than two times the upper limit of normal. The relationship for ALT appears specific for death due to cardiovascular disease. Links of low ALT with frailty, as a potential mechanism for relationships seen, were neither supported nor conclusively refuted by our analysis and other factors are also likely to be important in those with type 2 diabetes.
RCT Entities:
AIMS: Reported associations between liver enzymes and mortality may not hold true in type 2 diabetes, owing to a high prevalence of non-alcoholic fatty liver disease, which has been linked to cardiovascular disease and mortality in its own right. Our study aimed to determine whether alanine aminotransferase (ALT) or γ-glutamyl transferase (GGT) levels predict mortality in type 2 diabetes, and to examine possible mechanisms. METHODS: Data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study were analyzed to examine the relationship between liver enzymes and all-cause and cause-specific mortality over 5years. RESULTS: Over 5years, 679 (6.9%) individuals died. After adjustment, for every standard deviation increase in ALT (13.2U/L), the HR for death on study was 0.85 (95% CI 0.78-0.93), p<0.001. Conversely, GGT >70U/L, compared with GGT ≤70U/L, had HR 1.82 (1.48-2.24), p<0.001. For cause-specific mortality, lower ALT was associated with a higher risk of cardiovascular death only, whereas GGT >70U/L was associated with higher risks of death due to cardiovascular disease, cancer and non-cancer/non-cardiovascular causes. The relationship for ALT persisted after adjustment for indirect measures of frailty but was attenuated by elevated hsCRP. CONCLUSIONS: As in the general population, ALT has a negative, and GGT a positive, correlation with mortality in type 2 diabetes when ALT is less than two times the upper limit of normal. The relationship for ALT appears specific for death due to cardiovascular disease. Links of low ALT with frailty, as a potential mechanism for relationships seen, were neither supported nor conclusively refuted by our analysis and other factors are also likely to be important in those with type 2 diabetes.
Authors: Umberto Vespasiani-Gentilucci; Antonio De Vincentis; Luigi Ferrucci; Stefania Bandinelli; Raffaele Antonelli Incalzi; Antonio Picardi Journal: J Gerontol A Biol Sci Med Sci Date: 2018-06-14 Impact factor: 6.053
Authors: Mi Young Lee; Dae Sung Hyon; Ji Hye Huh; Hae Kyung Kim; Sul Ki Han; Jang Young Kim; Sang Baek Koh Journal: Endocrinol Metab (Seoul) Date: 2019-12