Low alanine aminotransferase levels and higher number of cardiovascular events in people with Type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

K H Williams, D R Sullivan, A S Veillard, R O'Brien, J George, A J Jenkins, S Young, C Ehnholm, A Duffield, S M Twigg, A C Keech

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Abstract

AIMS: To determine whether alanine aminotransferase or gamma-glutamyltransferase levels, as markers of liver health and non-alcoholic fatty liver disease, might predict cardiovascular events in people with Type 2 diabetes.

METHODS: Data from the Fenofibrate Intervention and Event Lowering in Diabetes study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (non-fatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years.

RESULTS: Alanine aminotransferase level had a linear inverse relationship with the first cardiovascular event occurring in participants during the study period. After adjustment, for every 1 sd higher baseline alanine aminotransferase value (13.2 U/l), the risk of a cardiovascular event was 7% lower (95% CI 4-13; P=0.02). Participants with alanine aminotransferase levels below and above the reference range 8-41 U/l for women and 9-59 U/l for men, had hazard ratios for a cardiovascular event of 1.86 (95% CI 1.12-3.09) and 0.65 (95% CI 0.49-0.87), respectively (P=0.001). No relationship was found for gamma-glutamyltransferase.

CONCLUSIONS: The data may indicate that in people with Type 2 diabetes, which is associated with higher alanine aminotransferase levels because of prevalent non-alcoholic fatty liver disease, a low alanine aminotransferase level is a marker of hepatic or systemic frailty rather than health. 

Original languageEnglish
Pages (from-to)356-364
Number of pages9
JournalDiabetic Medicine
Volume33
Issue number3
Early online date03 Oct 2015
DOIs
Publication statusPublished - Mar 2016

Keywords

  • diabetes

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    Williams, K. H., Sullivan, D. R., Veillard, A. S., O'Brien, R., George, J., Jenkins, A. J., Young, S., Ehnholm, C., Duffield, A., Twigg, S. M., & Keech, A. C. (2016). Low alanine aminotransferase levels and higher number of cardiovascular events in people with Type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Diabetic Medicine, 33(3), 356-364. https://doi.org/10.1111/dme.12972