title: Longitudinal change in serum gamma-glutamyltransferase and cardiovascular disease mortality: a prospective population-based study in 76,113 Austrian adults.
abstract: OBJECTIVE
  The purpose of this study was to investigate the association of longitudinal change in serum gamma-glutamyltransferase (GGT) with mortality from cardiovascular disease (CVD).
  
  
  RESULTS
  A population-based cohort of 76,113 Austrian men and women with 455,331 serial GGT measurements was prospectively followed-up for a median of 10.2 years after assessment of longitudinal GGT change during an average period of 6.9 years. Cox proportional hazards regression with time-varying covariates was used to evaluate GGT change as an independent predictor for CVD death. Independently of baseline GGT and other classical CVD risk factors, a pronounced increase in GGT (7-year change >9.2 U/L) was significantly associated with increased total CVD mortality in men (P=0.005); the adjusted hazard ratio (95% confidence interval) in comparison to stable GGT (7-year change -0.7 to 1.3 U/L) was 1.40 (1.09 to 1.81). Similarly, total CVD risk was elevated for increasing GGT in women, although effects were less pronounced and statistically significant only in subanalyses regarding coronary heart disease. Age of participants significantly modified the relation between GGT change and CVD mortality, with markedly stronger associations to be observable for younger individuals.
  
  
  CONCLUSIONS
  Our study is the first to demonstrate that a longitudinal increase in GGT, independently of baseline GGT and even within its normal range, significantly increases risk of fatal CVD.
authors.affiliation: Department of Medical Statistics, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Strasak
authors.forename: Cecily C
authors.initials: CC
authors.lastname: Kelleher
authors.forename: Jochen
authors.initials: J
authors.lastname: Klenk
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Brant
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Kilian
authors.initials: K
authors.lastname: Rapp
authors.forename: Hans
authors.initials: H
authors.lastname: Concin
authors.forename: Günter
authors.initials: G
authors.lastname: Diem
authors.forename: Karl P
authors.initials: KP
authors.lastname: Pfeiffer
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000201:enzymology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D015854:Up-Regulation; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase