Alanine aminotransferase and mortality in patients with type 2 diabetes (ZODIAC-38)

Petronella E. Deetman*, Alaa Alkhalaf, Gijs W. D. Landman, Klaas H. Groenier, Jenny E. Kootstra-Ros, Gerjan Navis, Henk J. G. Bilo, Nanne Kleefstra, Stephan J. L. Bakker

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

7 Citations (Scopus)

Abstract

Introduction Combined data suggest a bimodal association of alanine aminotransferase (ALT) with mortality in the general population. Little is known about the association of ALT with mortality in patients with type 2 diabetes. We therefore investigated the association of ALT with all-cause, cardiovascular and noncardiovascular mortality in patients with type 2 diabetes.

Design A prospective study was performed in patients with type 2 diabetes, treated in primary care, participating in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study. Cox regression analyses were performed to determine the associations of log(2)-transformed baseline ALT with all-cause, cardiovascular and noncardiovascular mortality.

Results In 1187 patients with type 2 diabetes (6712years, 45% female), ALT levels were 11 (8-16)U/L. During median follow-up for 111 (61-140)years, 553 (47%) patients died, with 238 (20%) attributable to cardiovascular causes. Overall, ALT was inversely associated with all-cause mortality (hazard ratio [HR] 081; 95% confidence interval [CI] 072-092), independently of potential confounders. This was less attributable to cardiovascular mortality (HR 087; 95% CI 072-105), than to noncardiovascular mortality (HR 077; 95% CI 065-090). Despite the overall inverse association of ALT with mortality, it appeared that a bimodal association with all-cause mortality was present with increasing risk for levels of ALT above normal (P=0003).

Discussion In patients with type 2 diabetes, low levels of ALT are associated with an increased risk of all-cause mortality, in particular noncardiovascular mortality, compared to normal levels of ALT, while risk again starts to increase when levels are above normal.

Original languageEnglish
Pages (from-to)807-814
Number of pages8
JournalEuropean Journal of Clinical Investigation
Volume45
Issue number8
DOIs
Publication statusPublished - Aug-2015

Keywords

  • Alanine aminotransferase
  • mortality
  • nonalcoholic fatty liver disease
  • type 2 diabetes
  • FATTY LIVER-DISEASE
  • UNITED-STATES POPULATION
  • ALL-CAUSE MORTALITY
  • METABOLIC SYNDROME
  • CARDIOVASCULAR EVENTS
  • HEART-DISEASE
  • OLDER-PEOPLE
  • FOLLOW-UP
  • RISK
  • ENZYMES

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