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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27:127.)
© 2007 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Gamma Glutamyl Transferase and Metabolic Syndrome, Cardiovascular Disease, and Mortality Risk

The Framingham Heart Study

Douglas S. Lee; Jane C. Evans; Sander J. Robins; Peter W. Wilson; Irene Albano; Caroline S. Fox; Thomas J. Wang; Emelia J. Benjamin; Ralph B. D’Agostino; Ramachandran S. Vasan

From the Institute for Clinical Evaluative Sciences and University Health Network (D.S.L.), University of Toronto, Canada; the National Heart, Lung, and Blood Institute’s Framingham Heart Study (J.C.E., S.J.R., C.S.F., T.J.W., E.J.B., R.B.D., R.S.V.), Framingham, Mass; the Endocrine-Metabolic Laboratory (I.A.), Department of Medical and Surgical Sciences, University of Padova, Italy; the Department of Medicine (P.W.W.), Medical University of South Carolina, Charleston; the Mathematics Department (R.B.D.), Boston University, Boston, Mass; the Cardiology Division (T.J.W.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass; the Cardiology Section (E.J.B., R.S.V.) and the Department of Preventive Medicine and Epidemiology (R.S.V.), Boston University School of Medicine, Boston, Mass.

Correspondence to Douglas S. Lee, MD, PhD, Institute for Clinical Evaluative Sciences, Division of Cardiology, University Health Network, University of Toronto, Rm G-106, 2075 Bayview Ave, Toronto, Ontario, M4N 3M5 Canada. E-mail dlee{at}ices.on.ca

Objective— To determine whether serum -glutamyl transferase (GGT) predicts cardiovascular disease (CVD) morbidity and mortality, accounting for temporal changes in known CVD risk factors and C-reactive protein (CRP).

Methods and Results— In 3451 Framingham Study participants (mean age 44 years, 52% women) we examined the relations of GGT with CVD risk factors, and prospectively determined the risk of new-onset metabolic syndrome, incident CVD, and death. GGT was positively associated with body mass index, blood pressure, LDL cholesterol, triglycerides, and blood glucose in cross-sectional analysis (P<0.005). On follow-up (mean 19 years), 968 participants developed metabolic syndrome, 535 developed incident CVD, and 362 died. The risk of metabolic syndrome increased with higher GGT (multivariable-adjusted hazard ratio [HR] per SD increment log-GGT, 1.26 [95%CI; 1.18 to 1.35]). Adjusting for established CVD risk factors (as time-dependent covariates updated quadriennially) and baseline CRP, a 1-SD increase in log-GGT conferred a 13% increase in CVD risk (P=0.007) and 26% increased risk of death (P<0.001). Individuals in the highest GGT quartile experienced a 67% increase in CVD incidence (multivariable-adjusted HR 1.67, 95%CI; 1.25 to 2.22).

Conclusion— An increase in serum GGT predicts onset of metabolic syndrome, incident CVD, and death suggesting that GGT is a marker of metabolic and cardiovascular risk.

To determine if serum -glutamyl transferase (GGT) is a predictor of cardiovascular disease (CVD) morbidity and mortality, we conducted time-dependent analysis accounting for temporal changes in CVD risk factors. Increased serum GGT predicted incident CVD and death. The highest GGT quartile experienced a 67% increase in CVD incidence.

Key Words: biomarkers • gamma glutamyl transferase • risk factor • cardiovascular disease • metabolic syndrome • mortality

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Gamma-Glutamyl Transferase: Another Biomarker for Metabolic Syndrome and Cardiovascular Risk

Scott M. Grundy
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