The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension

Liu, Hui; Ding, Congcong; Hu, Lihua; Li, Minghui; Zhou, Wei; Wang, Tao; Zhu, Lingjuan; Bao, Huihui; Cheng, Xiaoshu

doi:10.1097/md.0000000000026693

Cited by 29 publications

(29 citation statements)

References 33 publications

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“…The fact that in the multi-adjusted post-randomization model it tracked with γGT as an indicator of CV risk (Additional file 4 : Table S4) likely stands for a degree of liver dysfunction participating in the overall CV risk of the CANVAS population. Consistently, an association between AST/ALT ratio within the normal range and increased risk of all-cause and CV mortality has been previously reported in unselected populations with diabetes [ 41 ] and hypertension [ 42 ].…”

Section: Discussionsupporting

confidence: 77%

Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program

Ferrannini

Rosenthal

Hansen

et al. 2022

Cardiovasc Diabetol

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Background Raised liver function tests (LFTs) have been correlated with multiple metabolic abnormalities and variably associated with cardiorenal outcomes. We sought to systematically test the relationship between LFT levels within the accepted range and major cardiorenal outcomes in a large clinical trial in type 2 diabetes, and the possible impact of placebo-controlled canagliflozin treatment. Methods We measured serum alanine aminotransferase (ALT), aspartic aminotransferase (AST), gamma-glutamyl transferase (γGT), alkaline phosphatase (ALP), and bilirubin concentrations in 10,142 patients, at baseline and repeatedly over follow-up. The relation of LFTs to first hospitalized heart failure (HHF), cardiovascular (CV) and all-cause mortality, and progression of renal impairment was investigated using multivariate proportional-hazards models. Results In univariate association, ALT was reciprocally predictive, and ALP was positively predictive, of all adjudicated outcomes; γGT also was directly associated with CV—but not renal—outcomes. In multivariate models including all 5 LFTs and 19 potential clinical confounders, ALT was independently associated with lower, and γGT with higher, CV outcomes risk. Canagliflozin treatment significantly reduced ALT, AST, and γGT over time. In a fully adjusted model including updated LFT levels and treatment, γGT was independently associated with CV and all-cause mortality, ALP with renal dysfunction progression, and canagliflozin treatment with significant reduction in HHF and renal risk. Conclusions Higher γGT levels are top LFT markers of risk of HHF and death in patients with diabetes and high CV risk, while ALT are protective. Canagliflozin lowers the risk of HHF and renal damage independently of LFTs and potential confounders.

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Section: Discussionsupporting

confidence: 77%

Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program

Ferrannini

Rosenthal

Hansen

et al. 2022

Cardiovasc Diabetol

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“…A large sample cohort study with 14,220 participants examined the association between the AST/ALT ratio with ACM and cardiovascular mortality in hypertensive patients. This study found that an increased AST/ALT ratio was associated with increased risk of ACM (P value < 0.05) and cardiovascular mortality (P value < 0.05) in hypertensive patients 30 , after an average follow-up time of 1.7 years. Another study, based on the general population, followed 3494 participants for up to 10 years and found that the AST/ALT ratio increased with brain natriuretic peptide (BNP).…”

Section: Discussionmentioning

confidence: 62%

Elevated AST/ALT ratio is associated with all-cause mortality in patients with stable coronary artery disease: a secondary analysis based on a retrospective cohort study

Liu

2022

Sci Rep

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The aim of this study is to explore the association between the aspartate amino transferase (AST)/alanine aminotransferase (ALT) ratio and all-cause mortality (ACM) in stable coronary artery disease (CAD) patients treated by percutaneous coronary intervention (PCI). The study is a secondary analysis of a retrospective cohort study involving 203 stable CAD patients. Patients were divided into two groups, based on the optimal AST/ALT ratio threshold calculated by the ROC curve (low group: AST/ALT ratio < 1.40; high group: AST/ALT ratio ≥ 1.40). Results were compared using hazard ratio (HR) and a 95% confidence interval (CI). ACM occurred in 18 patients after an average follow-up time of 749 (435–1122) days. Among them, ACM occurred in 6 patients in the low group and 12 patients in the high group, with significant differences between the groups (4.65% versus 16.22%, P value = 0.005). In the Kaplan–Meier analysis, an elevated AST/ALT ratio was associated with increased ACM in stable ACD patients (HR 3.78, 95% CI 1.44–9.93, P value < 0.001). An elevated AST/ALT ratio was still found to be an independent prognostic factor for ACM (HR 2.93, 95% CI 1.08–7.91, P value = 0.034) after adjusting for potential confounders. Therefore, an elevated AST/ALT ratio is an independent prognostic factor for ACM in stable ACD patients.

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“…In addition, several studies have demonstrated that the AST/ALT ratio can be used as a risk predictor for cardiovascular diseases. In addition, several studies have shown that AST/ALT can be used as a risk predictor for cardiovascular disease 7,11,18,23 , nonalcoholic fatty liver 24 , hypertension 25 , obesity 26 , metabolic syndrome 27 , cognitive impairment 13 etc. The ALT/AST ratio may be more predictive of homeostatic model assessment for insulin resistance than the fasting insulin levels in nonobese, middle-aged, mixed-sex populations 17 .…”

Section: Discussionmentioning

confidence: 99%

Association of AST and ALT Ratio with Incidence of Diabetes in Chinese Adults: A Retrospective Cohort Study

Yao

Zhang

et al. 2023

Preprint

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Purpose Little research exits on the effect of the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio on the incidence of diabetes mellitus (DM). This study used the large-scale cohort study data of the Chinese population to explore the effect of the AST/ALT ratio on the incidence of DM. Patients and methods The data was downloaded from a computerized database (DATADRYAD, available at www.datadryad.org) including 32 sites and 11 cities in China which were collected between 2010 and 2016 by the Rich Healthcare Group in China. This study was a retrospective cohort study that, included 86,145 participants for the secondary analysis. Multivariable Cox proportional hazards regression and a two-piecewise linear regression model were used to explore the relationship between the AST/ ALT ratio and DM. Results The AST/ALT ratio was negatively correlated with the incidence of DM after adjusting for potential co-variables [HR = 0.44, (95%CI:0.38–0.51), P < 0.001]. By using the two-piecewise linear regression model, the inflection point was 1.3. On the left of the inflection point, the effect size was HR = 0.3 (0.2–0.3, P < 0.001). On the right side of the inflection point, the effect size was HR = 0.9 (0.7 to 1.2; P = 0.561). Conclusion The AST/ALT ratio could be an independent predictor of incident DM and was negatively correlated with DM events.

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The association between AST/ALT ratio and all-cause and cardiovascular mortality in patients with hypertension

Cited by 29 publications

References 33 publications

Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program

Liver function markers predict cardiovascular and renal outcomes in the CANVAS Program

Elevated AST/ALT ratio is associated with all-cause mortality in patients with stable coronary artery disease: a secondary analysis based on a retrospective cohort study

Association of AST and ALT Ratio with Incidence of Diabetes in Chinese Adults: A Retrospective Cohort Study

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