The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes

Abstract

An increased aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) has been widely used as a marker of advanced hepatic fibrosis. Increased AAR was also shown to be significantly associated with the risk of developing cardiovascular (CV) disease. The aim of this study was to assess the relationship between the AAR and mortality risk in a well-characterized cohort of patients with type 2 diabetes.A cohort of 2529 type 2 diabetic outpatients was followed-up for 6 years to collect cause-specific mortality. Cox regression analyses were modeled to estimate the independent association between AAR and the risk of all-cause and CV mortality.Over the 6-year follow-up period, 12.1% of patients died, 47.5% of whom from CV causes. An increased AAR, but not its individual components, was significantly associated with an increased risk of all-cause (adjusted-hazard risk 1.83, confidence interval [CI] 95% 1.14–2.93, P = 0.012) and CV (adjusted-hazard risk 2.60, CI 95% 1.38–4.90, P < 0.003) mortality after adjustment for multiple clinical risk factors and potential confounding variables.The AAR was independently associated with an increased risk of both all-cause and CV mortality in patients with type 2 diabetes. These findings suggest that an increased AAR may reflect more systemic derangements that are not simply limited to liver damage. Further studies are needed to elucidate the pathophysiological implications of an increased AAR.

AST/ALT ratio predicts the functional severity of chronic heart failure with reduced left ventricular ejection fraction

“…Zoppini et al [27] studied patients with type 2 diabetes mellitus and found that the AST/ALT ratio positively correlated with CVD mortality; however, as in the above studies, they did not include HFrEF patients.…”

Association between Aminotransferase/alanine Aminotransferase Ratio and Cardiovascular Disease mortality in Patients on Peritoneal Dialysis

“…The Italy 6-year follow-up study with 2529 diabetes showed that the AST/ALT ratio had an independent association with all-cause and CVD mortality. Patients with a known history of drug-induced liver injury, viral hepatitis, cirrhosis of any etiology, and hemochromatosis were also excluded, but those with a history of CVD failed to be excluded in this study [25]. More recently, a 10year follow-up prospective study of 29,316 participants aged between 25 and 84 years from the United Kingdom showed that an increased AST/ALT ratio were at signi cant risk of developing CVD episodes in male participants but not those female, with no baseline pre-existing CVD [13].…”

A Novel Biomarker for Prediction of Atrial Fibrillation Susceptibility in Patients with Celiac Disease

“…There are numerous non-invasive methods that can be used for the prediction of fibrosis, including the AST/ALT ratio (AAR), APRI, FIB4 and the NAFLD fibrosis score [13,14,[16][17][18]. For the aim of the study, it was important that we choose a parameter that has been used in predicting cardiovascular diseases [19,[37][38][39][40][41]. Therefore, we used AAR for the prediction of fibrosis risk in CD patients.…”