title: γ-Glutamyltransferase, but not markers of hepatic fibrosis, is associated with cardiovascular disease in older people with type 2 diabetes mellitus: the Edinburgh Type 2 Diabetes Study.
abstract: OBJECTIVE
  We examined the association of prevalent and incident cardiovascular disease (CVD) with chronic liver disease in a cohort of community-based people with type 2 diabetes, in order to clarify the relationship between these two important conditions.
  
  
  METHODS
  1,066 participants with type 2 diabetes aged 60-75 years underwent assessment of a range of liver injury markers (non-specific injury, steatosis, steatohepatitis, fibrosis, portal hypertension). Individuals were followed up for incident cardiovascular events.
  
  
  RESULTS
  At baseline there were 370/1,033 patients with prevalent CVD, including 317/1,033 with coronary artery disease (CAD). After a mean follow-up of 4.4 years there were 44/663 incident CVD events, including 27/663 CAD events. There were 30/82 CVD-related deaths. Risk of dying from or developing CVD was no higher in participants with steatosis than in those without (HR 0.90; 95% CI 0.40, 2.00; p > 0.05). The only notable relationship was with γ-glutamyltransferase (GGT) (incident CVD: adjusted HR for doubling GGT 1.24 [95% CI 0.97, 1.59] p = 0.086; incident CAD: adjusted HR 1.33 [95% CI 1.00, 1.78] p = 0.053), suggesting that in our study population, chronic liver disease may have little effect on the development of, or mortality from, CVD.
  
  
  CONCLUSIONS
  An independent association between GGT and CVD warrants further exploration as a potentially useful addition to current cardiovascular risk prediction models in diabetes. However, overall findings failed to suggest that there is a clinical or pathophysiological association between chronic liver disease and CVD in elderly people with type 2 diabetes.
authors.affiliation: Centre for Population Health Sciences, University of Edinburgh, Old Medical Buildings, Teviot Place, Edinburgh, EH8 9AG, UK, J.morling@ed.ac.uk.
authors.forename: Joanne R
authors.initials: JR
authors.lastname: Morling
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Fallowfield
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Williamson
authors.forename: Christine M
authors.initials: CM
authors.lastname: Robertson
authors.forename: Stephen
authors.initials: S
authors.lastname: Glancy
authors.forename: Indra N
authors.initials: IN
authors.lastname: Guha
authors.forename: Mark W J
authors.initials: MW
authors.lastname: Strachan
authors.forename: Jackie F
authors.initials: JF
authors.lastname: Price
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000097:blood* / Q000201:enzymology / Q000453:epidemiology*; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000201:enzymology / Q000453:epidemiology*; D005234:Fatty Liver / Q000453:epidemiology; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood*; D008111:Liver Function Tests; D008297:Male; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase
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