title: Alanine transaminase has opposite associations with death from diabetes and ischemic heart disease in NHANES III.
abstract: OBJECTIVE
  Diabetes increases the risk of ischemic heart disease (IHD). Stringent control of diabetes does not reliably reduce cardiovascular events. Some global regions, such as East Asia, have low mortality rates from IHD and high rates of diabetes. We hypothesized that some aspects of liver function might underlie this paradox.
  
  
  METHODS
  We used multivariable proportional hazards regression in 16,865 adults from the National Health and Nutrition Examination Survey (NHANES) III (1988-1994) followed until December 31, 2006, to assess the adjusted associations of gender-specific tertiles of alanine transaminase (ALT), as a marker of hepatocellular damage, and bilirubin (BIL), as a marker of other aspects of liver function, with death from diabetes (n = 132), IHD related to diabetes (n = 153), and IHD unrelated to diabetes (n = 921).
  
  
  RESULTS
  ALT was positively associated with death from diabetes (hazard ratio [HR], 2.17; 95% confidence interval [CI], 1.19-3.98 for high compared with low ALT tertile) and IHD related to diabetes (HR, 2.14; 95% CI, 1.07-4.31), but negatively associated with IHD unrelated to diabetes (HR, 0.76; 95% CI, 0.58-0.98) adjusted for age, gender, education, race/ethnicity, smoking, and alcohol use. BIL had no such associations.
  
  
  CONCLUSIONS
  ALT may be a marker of an underlying etiology relating to the paradoxical associations of diabetes and IHD at a population level.
authors.affiliation: CUNY School of Public Health at Hunter College, New York, USA. mschooli@hunter.cuny.edu
authors.forename: C Mary
authors.initials: CM
authors.lastname: Schooling
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Kelvin
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000097:blood / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038801:International Classification of Diseases; D007407:Interviews as Topic; D008107:Liver Diseases / Q000097:blood / Q000401:mortality*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000097:blood / Q000401:mortality*; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase