Alonso Alvaro, Misialek Jeffrey R, Amiin Mohamed A, Hoogeveen Ron C, Chen Lin Y, Agarwal Sunil K, Loehr Laura R, Soliman Elsayed Z, Selvin Elizabeth
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minneapolis, USA.
Department of Medicine, Baylor College of Medicine and Methodist DeBakey Heart & Vascular Center, Houston, Texas, USA.
Heart. 2014 Oct;100(19):1511-6. doi: 10.1136/heartjnl-2014-305756. Epub 2014 Jun 12.
Elevated levels of circulating liver enzymes have been associated with increased risk of cardiovascular disease. Their possible association with atrial fibrillation (AF) has received little attention.
We studied 9333 men and women, aged 53-75 years, free of AF, participating in the Atherosclerosis Risk in Communities Study followed-up from 1996 to 2010. Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and γ glutamyl transpeptidase (GGT) were measured in stored plasma samples. Incident AF was ascertained from hospitalisations and death certificates. Associations between liver enzymes and AF incidence were assessed using multivariable Cox proportional hazards models.
During a mean follow-up of 12 years, 1021 incident AF events were identified. Levels of AST, and to a lesser extent ALT, showed a U-shaped association with AF risk, with higher AF risk among individuals in the two extremes of the distribution in minimally adjusted models. The associations were weakened after adjustment for potential confounders. By contrast, GGT, modelled as log base 2, was linearly associated with AF risk after multivariable adjustment: a doubling of GGT levels was associated with a 20% increased risk of AF (95% CI 10% to 30%). Additional adjustment for inflammatory markers did not appreciably affect the results. Associations were not different in men and women, in whites and blacks, among never drinkers of alcohol, and among those without prevalent heart failure.
In this community-based prospective study, higher levels of liver enzymes, mainly GGT, were associated with an increased risk of AF. The mechanisms underlying this association deserve further scrutiny.
循环肝酶水平升高与心血管疾病风险增加有关。它们与心房颤动（AF）的可能关联很少受到关注。
我们研究了9333名年龄在53 - 75岁、无房颤的男性和女性，他们参与了社区动脉粥样硬化风险研究，随访时间从1996年至2010年。在储存的血浆样本中测量天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和γ-谷氨酰转肽酶（GGT）。通过住院记录和死亡证明确定新发房颤。使用多变量Cox比例风险模型评估肝酶与房颤发病率之间的关联。
在平均12年的随访期间，共识别出1021例新发房颤事件。AST水平以及程度较轻的ALT水平与房颤风险呈U形关联，在最小调整模型中，分布两端的个体房颤风险较高。在对潜在混杂因素进行调整后，这种关联减弱。相比之下，以2为底的对数形式建模的GGT在多变量调整后与房颤风险呈线性关联：GGT水平翻倍与房颤风险增加20%相关（95%CI 10%至30%）。对炎症标志物进行额外调整并未明显影响结果。在男性和女性、白人和黑人、从不饮酒者以及无心力衰竭病史者中，关联无差异。
在这项基于社区的前瞻性研究中，较高水平的肝酶，主要是GGT，与房颤风险增加有关。这种关联背后的机制值得进一步研究。
