Circulating gamma glutamyltransferase and prediction of cardiovascular disease

Kunutsor, Setor K; Bakker, Stephan J. L.; Kootstra‐Ros, Jenny E.; Gansevoort, Ronald; Dullaart, Robin P. F.

doi:10.1016/j.atherosclerosis.2014.12.045

Cited by 54 publications

(58 citation statements)

References 43 publications

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“…Floating variances were used as described previously. [23,24] We modelled our exposure as both continuous [per unit (ml/kg/min) and 1 MET increase] and categorical (quartiles) variables. We calculated age-, multivariable-, and multivariable plus peak VO2-adjusted HRs for each outcome.…”

Section: Discussionmentioning

confidence: 99%

Associations of cardiovascular and all-cause mortality events with oxygen uptake at ventilatory threshold

Kunutsor

Kurl

Khan

et al. 2017

International Journal of Cardiology

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General rightsThis document is made available in accordance with publisher policies. Please cite only the published version using the reference above. Full terms of use are available: http://www.bristol.ac.uk/pure/about/ebr-terms Abbreviations BMI = body mass index CHD = coronary heart disease CRF = cardiorespiratory fitness CVD = cardiovascular disease HDL-C = high-density lipoprotein cholesterol HR = hazard ratio IDI = integrated-discrimination-improvement KIHD = Kuopio Ischaemic Heart Disease NRI = net reclassification improvement SCD = sudden cardiac death SD = standard deviation SBP = systolic blood pressure VT = ventilatory threshold VO2 = oxygen uptake ABSTRACTBackground: Oxygen uptake (VO2) at ventilatory threshold (VT), is a cardiopulmonary exercise testing parameter which may be a proxy for peak VO2. We aimed to assess the associations of VO2 at VT with sudden cardiac death (SCD), fatal coronary heart disease (CHD) and cardiovascular disease (CVD), and all-cause mortality.Methods and Results: VO2 at VT was assessed during a submaximal exercise test using respiratory gas analyzers in the Kuopio Ischemic Heart Disease cohort of 1,639 middle-aged men. Hazard ratios (HRs) (95% CIs) were assessed. During a median follow-up of 25.6 years, 121 SCDs, 202 fatal CHDs, 312 fatal CVDs, and 703 all-cause mortality events occurred. VO2 at VT was correlated with peak VO2 (r = 0.90) and linearly associated with each outcome. Comparing extreme quartiles of VO2 at VT, the HRs (95% CIs) for SCD, fatal CHD, fatal CVD, and all-cause mortality on adjustment for established risk factors Conclusions: There are linear and inverse associations of VO2 at VT with fatal cardiovascular and allcause mortality events, which are dependent on peak VO2. Inclusion of VO2 at VT in the standard established risk factors panel significantly improves the prediction and classification of long-term CVD mortality risk.

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Section: Discussionmentioning

confidence: 99%

Associations of cardiovascular and all-cause mortality events with oxygen uptake at ventilatory threshold

Kunutsor

Kurl

Khan

et al. 2017

International Journal of Cardiology

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“…The study design details and recruitment have been described in previous reports 17, 18. Participants in PREVEND consisted of a representative sample of inhabitants living in the city of Groningen in the Netherlands.…”

Section: Methodsmentioning

confidence: 99%

Self‐Reported Smoking, Urine Cotinine, and Risk of Cardiovascular Disease: Findings From the PREVEND (Prevention of Renal and Vascular End‐Stage Disease) Prospective Cohort Study

Kunutsor

Spee

Kieneker

et al. 2018

JAHA

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BackgroundWe aimed to compare the associations of smoking exposure as assessed by self‐reports and urine cotinine with cardiovascular disease (CVD) risk and determine the potential utility of cotinine for CVD risk prediction.Methods and ResultsSmoking status by self‐reports and urine cotinine were assessed at baseline in 4737 participants (mean age, 53 years) of the PREVEND (Prevention of Renal and Vascular End‐Stage Disease) prospective study. Participants were classified as never, former, light current (≤10 cigarettes/day), and heavy current smokers (>10 cigarettes/day) according to self‐reports and analogous cutoffs for urine cotinine. During a median follow‐up of 8.5 years, 296 first CVD events were recorded. Compared with self‐reported never smokers, the hazard ratios (95% confidence interval) of CVD for former, light current, and heavy current smokers were 0.86 (0.64–1.17), 1.28 (0.83–1.97), and 1.80 (1.27–2.57) in multivariate analysis. Compared with urine cotinine–assessed never smokers, the corresponding hazard ratios of CVD for urine cotinine–assessed former, light current, and heavy current smokers were 1.70 (1.03–2.81), 1.62 (1.15–2.28), and 1.95 (1.39–2.73) respectively. The C‐index change on adding urine cotinine–assessed smoking status to a standard CVD risk prediction model (without self‐reported smoking status) was 0.0098 (0.0031–0.0164; P=0.004). The corresponding C‐index change for self‐reported smoking status was 0.0111 (0.0042–0.0179; P=0.002).ConclusionsSmoking status as assessed by self‐reports and urine cotinine is associated with CVD risk; however, the nature of the association of urine cotinine with CVD is consistent with a dose‐response relationship. The ability of urine cotinine to improve CVD risk assessment is similar to that of self‐reported smoking status.

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“…Although, it has been suggested that GGT appears to pass the Vasan's criteria (93) as a biomarker of increased cardiovascular risk (89), the intricate association of GGT with cardiovascular risk factors and comorbidities, particularly the liver disease, raises serious questions regarding a direct role of GGT in the pathophysiology of CVD or causality in the GGT-CVD relationship. Recent data suggested that adding GGT to conventional cardiovascular risk factors did not improve the risk prediction for CVD or CHD-related mortality (44,64,94). Thus, at this stage, the crucial question whether GGT has a direct role in the pathophysiology of CVD or it is an epiphenomenon of coexisting CVD risk factors or comorbidities remains unanswered.…”

Section: Concluding Remarks and Perspectivementioning

confidence: 99%

Gamma-glutamyl transferase and cardiovascular disease

Ndrepepa¹,

Kastrati²

2016

Ann. Transl. Med.

105

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Gamma-glutamyl transferase (GGT) is an enzyme located on the external surface of cellular membranes. GGT contributes in maintaining the physiological concentrations of cytoplasmic glutathione and cellular defense against oxidative stress via cleavage of extracellular glutathione and increased availability of amino acids for its intracellular synthesis. Increased GGT activity is a marker of antioxidant inadequacy and increased oxidative stress. Ample evidence suggests that elevated GGT activity is associated with increased risk of cardiovascular disease (CVD) such as coronary heart disease (CHD), stroke, arterial hypertension, heart failure, cardiac arrhythmias and all-cause and CVD-related mortality. The evidence is weaker for an association between elevated GGT activity and acute ischemic events and myocardial infarction. The risk for CVD or CVD-related mortality mediated by GGT may be explained by the close correlation of GGT with conventional CVD risk factors and various comorbidities, particularly non-alcoholic fatty liver disease, alcohol consumption, oxidative stress, metabolic syndrome, insulin resistance and systemic inflammation. The finding of GGT activity in atherosclerotic plaques and correlation of intra-plaque GGT activity with histological indexes of plaque instability may suggest a participation of GGT in the pathophysiology of CVD, particularly atherosclerosis. However, whether GGT has a direct role in the pathophysiology of CVD or it is an epiphenomenon of coexisting CVD risk factors or comorbidities remains unknown and Hill's criteria of causality relationship between GGT and CVD are not fulfilled. The exploration whether GGT provides prognostic information on top of the information provided by known cardiovascular risk factors regarding the CVD or CVD-related outcome and exploration of molecular mechanisms of GGT involvement in the pathophysiology of CVD and eventual use of interventions to reduce circulating GGT activity remain a duty of future studies.

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Circulating gamma glutamyltransferase and prediction of cardiovascular disease

Cited by 54 publications

References 43 publications

Associations of cardiovascular and all-cause mortality events with oxygen uptake at ventilatory threshold

Associations of cardiovascular and all-cause mortality events with oxygen uptake at ventilatory threshold

Self‐Reported Smoking, Urine Cotinine, and Risk of Cardiovascular Disease: Findings From the PREVEND (Prevention of Renal and Vascular End‐Stage Disease) Prospective Cohort Study

Gamma-glutamyl transferase and cardiovascular disease

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