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Gamma-glutamyl transferase and cardiovascular risk in nonalcoholic fatty liver disease: The Gut and Obesity Asia initiative

Pitisuttithum P 1 , Chan WK 2 , Goh GB 3 , Fan JG 4 , Song MJ 5 , Charatcharoenwitthaya P 6 Show all authors , Duseja A 7 , Dan YY 8 , Imajo K 9 , Nakajima A 9 , Ho KY 8 , Goh KL 2 , Wong VW 10 , Treeprasertsuk S 11

Affiliations 

  • 1 Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
  • 2 Department of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
  • 3 Department of Gastroenterology & Hepatology, Singapore General Hospital, Singapore 169608, Singapore
  • 4 Department of Gastroenterology, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
  • 5 Department of Internal Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea
  • 6 Division of Gastroenterology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
  • 7 Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
  • 8 Department of Medicine, National University of Singapore 119228, Singapore
  • 9 Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Yokohama 236-0004, Japan
  • 10 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong 999077, China
  • 11 Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand. battan5410@gmail.com
World J Gastroenterol, 2020 May 21;26(19):2416-2426.
PMID: 32476802 DOI: 10.3748/wjg.v26.i19.2416

Abstract

BACKGROUND: Gamma-glutamyl transferase (GGT) is associated with the risk of cardiovascular disease (CVD) in the general population.

AIM: To identify the association of baseline GGT level and QRISK2 score among patients with biopsy-proven nonalcoholic fatty liver disease (NAFLD).

METHODS: This was a retrospective study involving 1535 biopsy-proven NAFLD patients from 10 Asian centers in 8 countries using data collected by the Gut and Obesity in Asia (referred to as "GO ASIA") workgroup. All patients with available baseline GGT levels and all 16 variables for the QRISK2 calculation (QRISK2-2017; developed by researchers at the United Kingdom National Health Service; https://qrisk.org/2017/; 10-year cardiovascular risk estimation) were included and compared to healthy controls with the same age, sex, and ethnicity. Relative risk was reported. QRISK2 score > 10% was defined as the high-CVD-risk group. Fibrosis stages 3 and 4 (F3 and F4) were considered advanced fibrosis.

RESULTS: A total of 1122 patients (73%) had complete data and were included in the final analysis; 314 (28%) had advanced fibrosis. The median age (interquartile range [IQR]) of the study population was 53 (44-60) years, 532 (47.4%) were females, and 492 (43.9%) were of Chinese ethnicity. The median 10-year CVD risk (IQR) was 5.9% (2.6-10.9), and the median relative risk of CVD over 10 years (IQR) was 1.65 (1.13-2.2) compared to healthy individuals with the same age, sex, and ethnicity. The high-CVD-risk group was significantly older than the low-risk group (median [IQR]: 63 [59-67] vs 49 [41-55] years; P < 0.001). Higher fibrosis stages in biopsy-proven NAFLD patients brought a significantly higher CVD risk (P < 0.001). Median GGT level was not different between the two groups (GGT [U/L]: Median [IQR], high risk 60 [37-113] vs low risk 66 [38-103], P = 0.56). There was no correlation between baseline GGT level and 10-year CVD risk based on the QRISK2 score (r = 0.02).

CONCLUSION: The CVD risk of NAFLD patients is higher than that of healthy individuals. Baseline GGT level cannot predict CVD risk in NAFLD patients. However, advanced fibrosis is a predictor of a high CVD risk.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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