title: Low alanine aminotransferase levels and higher number of cardiovascular events in people with Type 2 diabetes: analysis of the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.
abstract: OBJECTIVE
  To determine whether alanine aminotransferase or gamma-glutamyltransferase levels, as markers of liver health and non-alcoholic fatty liver disease, might predict cardiovascular events in people with Type 2 diabetes.
  
  
  METHODS
  Data from the Fenofibrate Intervention and Event Lowering in Diabetes study were analysed to examine the relationship between liver enzymes and incident cardiovascular events (non-fatal myocardial infarction, stroke, coronary and other cardiovascular death, coronary or carotid revascularization) over 5 years.
  
  
  RESULTS
  Alanine aminotransferase measure had a linear inverse relationship with the first cardiovascular event occurring in participants during the study period. After adjustment, for every 1 sd higher baseline alanine aminotransferase measure (13.2 U/l), the risk of a cardiovascular event was 7% lower (95% CI 4-13; P = 0.02). Participants with alanine aminotransferase levels below and above the reference range 8-41 U/l for women and 9-59 U/l for men, had hazard ratios for a cardiovascular event of 1.86 (95% CI 1.12-3.09) and 0.65 (95% CI 0.49-0.87), respectively (P = 0.001). No relationship was found for gamma-glutamyltransferase.
  
  
  CONCLUSIONS
  The data may indicate that in people with Type 2 diabetes, which is associated with higher alanine aminotransferase levels because of prevalent non-alcoholic fatty liver disease, a low alanine aminotransferase level is a marker of hepatic or systemic frailty rather than health.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Royal Prince Alfred Hospital, Sydney, NSW, Australia.|National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: K H
authors.initials: KH
authors.lastname: Williams
authors.affiliation: Royal Prince Alfred Hospital, Sydney, NSW, Australia.|National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: D R
authors.initials: DR
authors.lastname: Sullivan
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: A S
authors.initials: AS
authors.lastname: Veillard
authors.affiliation: Austin Hospital, Melbourne, VIC, Australia.
authors.forename: R
authors.initials: R
authors.lastname: O'Brien
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, Sydney, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: George
authors.affiliation: National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Jenkins
authors.affiliation: Diabetes Clinic, Northshore Hospital, Auckland, New Zealand.
authors.forename: S
authors.initials: S
authors.lastname: Young
authors.affiliation: Biomedicum Helsinki, Helsinki, Finland.
authors.forename: C
authors.initials: C
authors.lastname: Ehnholm
authors.affiliation: Clinical Research Centre, Royal Hobart Hospital, Hobart, Tasmania, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Duffield
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia.|Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: S M
authors.initials: SM
authors.lastname: Twigg
authors.affiliation: Royal Prince Alfred Hospital, Sydney, NSW, Australia.|National Health and Medical Research Council Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia.
authors.forename: A C
authors.initials: AC
authors.lastname: Keech
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D011345:Fenofibrate / Q000627:therapeutic use*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase; C554782:gamma-glutamyltransferase, human; D000410:Alanine Transaminase; D011345:Fenofibrate