This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: 28/10/1857    most recent ATVBAHA.108.170597v1 Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Strasak, A. M. Search for Related Content PubMed PubMed Citation Articles by Strasak, A. M. Pubmed/NCBI databases Substance via MeSH

(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:1857.)
© 2008 American Heart Association, Inc.

Clinical and Population Studies

Longitudinal Change in Serum Gamma-Glutamyltransferase and Cardiovascular Disease Mortality

A Prospective Population-Based Study in 76 113 Austrian Adults

Alexander M. Strasak; Cecily C. Kelleher; Jochen Klenk; Larry J. Brant; Elfriede Ruttmann; Kilian Rapp; Hans Concin; Günter Diem; Karl P. Pfeiffer; Hanno Ulmer; the VHM&PP Study Group

From the Department of Medical Statistics, Informatics, and Health Economics (A.M.S., K.P.P., H.U.), Innsbruck Medical University, Austria; the School of Public Health and Population Sciences (C.C.K.), University College Dublin, Ireland; the Institute of Epidemiology (J.K., K.R.), Ulm University, Germany; the Gerontology Research Center (L.J.B.), National Institute on Aging, Baltimore, Md; the Department of Cardiac Surgery (E.R.), Innsbruck Medical University, Austria; and the Agency for Preventive and Social Medicine (H.C., G.D., H.U,), Bregenz, Austria.

Correspondence to Hanno Ulmer, PhD, Associate Professor, Department of Medical Statistics, Informatics, and Health Economics, Innsbruck Medical University, Schoepfstrasse 41, 6020 Innsbruck, Austria. E-mail hanno.ulmer{at}i-med.ac.at

Objective— The purpose of this study was to investigate the association of longitudinal change in serum -glutamyltransferase (GGT) with mortality from cardiovascular disease (CVD).

Methods and Results— A population-based cohort of 76 113 Austrian men and women with 455 331 serial GGT measurements was prospectively followed-up for a median of 10.2 years after assessment of longitudinal GGT change during an average period of 6.9 years. Cox proportional hazards regression with time-varying covariates was used to evaluate GGT change as an independent predictor for CVD death. Independently of baseline GGT and other classical CVD risk factors, a pronounced increase in GGT (7-year change >9.2 U/L) was significantly associated with increased total CVD mortality in men (P=0.005); the adjusted hazard ratio (95% confidence interval) in comparison to stable GGT (7-year change –0.7 to 1.3 U/L) was 1.40 (1.09 to 1.81). Similarly, total CVD risk was elevated for increasing GGT in women, although effects were less pronounced and statistically significant only in subanalyses regarding coronary heart disease. Age of participants significantly modified the relation between GGT change and CVD mortality, with markedly stronger associations to be observable for younger individuals.

Conclusion— Our study is the first to demonstrate that a longitudinal increase in GGT, independently of baseline GGT and even within its normal range, significantly increases risk of fatal CVD.

We prospectively investigated the association of longitudinal GGT change with CVD mortality in 76 113 men and women. We found increasing GGT, even within its normal range, to significantly increase risk of fatal CVD, independently of baseline GGT and other classical CVD risk factors.

Key Words: cardiovascular disease mortality • -glutamyltransferase • longitudinal change • risk factor • epidemiology

This article has been cited by other articles:

				T. Bose, V. S. Voruganti, M. E. Tejero, J. M. Proffitt, L. A. Cox, J. L. VandeBerg, M. C. Mahaney, J. Rogers, J. H. Freeland-Graves, S. A. Cole, et al. Quantitative Loci Regulating Plasma Levels of {gamma} Glutamyl Transferase and Albumin and Their Genetic Correlations with Cardiovascular Risk Factors Experimental Biology and Medicine, December 1, 2009; 234(12): 1519 - 1524. [Abstract] [Full Text] [PDF]

				G. Poelzl, C. Eberl, H. Achrainer, J. Doerler, O. Pachinger, M. Frick, and H. Ulmer Prevalence and Prognostic Significance of Elevated {gamma}-Glutamyltransferase in Chronic Heart Failure Circ Heart Fail, July 1, 2009; 2(4): 294 - 302. [Abstract] [Full Text] [PDF]