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.
- Alanine aminotransferase
- nonalcoholic fatty liver disease
- type 2 diabetes
- FATTY LIVER-DISEASE
- UNITED-STATES POPULATION
- ALL-CAUSE MORTALITY
- METABOLIC SYNDROME
- CARDIOVASCULAR EVENTS