Serum Alanine Aminotransferase Is Associated With Metabolic Diseases And Predicted Risk Of Cardiovascular Disease

Background With the development of society,inevitable trend of urbanization and rapid changes of lifestyles,the incidence of metabolic disease and cardiovascular disease increased recently,threatening human health and development of society severely.Aims: We aimed to identify cardiovascular and metabolic risk factors to maintain human health and take positive and effective measures.Study Design and Methods The relationship between serum alanine aminotransferase and metabolic diseases: Using cluster sampling,we performed our investigation among participants from Shanghai Jiading community-based cohort study at baseline(n=10 375)and during follow-up(n=4 499).A standard questionnaire was used to obtain the information on sociodemographic,medical history,family history and lifestyle behaviors.Anthropometric measurements included weight,height,waist circumference and blood pressure.Oral glucose tolerance test(OGTT)or a standard meal test was performed in each individual,and blood was collected to take biochemical measurements at 0 and 2 hours during the test.The 10-year cardiovascular risk was calculated using a 10-year Atherosclerotic Cardiovascular Disease(ASCVD)risk score.Results Among middle-aged and elderly Chinese,the incidence rate of metabolic syndrome gradually increased with the elevation of serum alanine aminotransferase.Logistic regression analysis revealed that being in the second,third and fourth serum alanine aminotransferase quartiles were associated with an increased risk of prevalent metabolic syndrome compared with being in the first quartile(adjusted odds ratio(OR)1.20(95% confidence interval(CI)1.02-1.42),1.36(1.15-1.61),and 2.00(1.69-2.36)respectively,P for trend < 0.0001).During a median of 4.0 years of follow-up,a total of 284(8.88%)women and 128(9.84%)men developed diabetes.Multi-variate logistic regression analysis indicated that the risk of incident diabetes increased according to the quartiles of alanine aminotransferase(OR,95% CI of the 4th quartile was 2.04,1.50-2.78).Moreover,increment per 5 U/ml or per 1 standard deviation(SD)for alanine aminotransferase was associated with increased risk of incident diabetes [1.32(1.20-1.46)or 1.24(1.15-1.35)].Increased alanine aminotransferase levels were associated with more unfavorable cardiovascular risk profiles and 10-year risk for ASCVD.Increased ALT levels were associated with the prevalence of type 2 diabetes(T2DM)in female participants,while in male participants the prevalence of T2 DM appears as a U-distribution.The prevalence of hypertension and dislipidemia were 66.04%,52.74% and 64.49%,47.63 % respectively.Increased serum alanine aminotransferase was associated with higher prevalence of 10-year risk for ASCVD.As compared with participants in the first lanine aminotransferase quartile,the risks of 10-year risk for ASCVD were increased by 148 %(OR 2.48,95% CI 1.78-3.45)and 139%(OR 2.39,95% CI 1.78-3.19),respectively in male and female participants.Multiple confounding factors were futher corrected,we found that as compared with participants in the first alanine aminotransferase quartile,higher prevalenc of 10-year risk for ASCVD were increased by 196%(OR 1.96,95% CI 1.30-2.95),while there was no significantly statistical difference in men(OR 1.15,95% CI 0.78-1.70).Conclusions In the middle-aged and elderly Chinese,serum alanine aminotransferase within normal range is significantly associated with increased risk of incident metabolic syndrome and diabetes.In addition,a high-normal serum alanine aminotransferase level was significantly associated with an increased risk of the cardiovascular disease.Adding alanine aminotransferase to conventional risk factors could significantly improve the prediction of incident metabolic syndrome,diabetes and cardiovascular disease.