The value of aspartate aminotransferase and alanine aminotransferase in cardiovascular disease risk assessment.
The value of aspartate aminotransferase and alanine aminotransferase in cardiovascular disease risk assessment.
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DOI：
10.1136/openhrt-2015-000272
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发表时间：
2015
期刊：
影响因子：
2.7
通讯作者：
Qureshi N
中科院分区：
文献类型：
--
作者：
Weng SF;Kai J;Guha IN;Qureshi N
天冬氨酸氨基转移酶与丙氨酸氨基转移酶（AST/ALT）的比值反映了肝脏疾病的严重程度，与心血管疾病（CVD）的风险增加相关。本研究的目的是评估AST/ALT比值是否改善了初级保健人群中已建立的风险预测工具。分析了29316例英国初级保健患者的前瞻性队列数据，这些患者年龄在25-84岁之间，基线时无CVD病史。 基于两种已建立的风险预测工具（Fracture和QRISK 2），使用考克斯比例风险回归推导首次发生CVD的10年多变量风险模型，包括和不包括AST/ALT比值。总体而言，通过判别准确度（AUC c-统计量）评估模型性能。在120462人年的总随访期间，782例患者（59%男性）发生了首次CVD事件。 多变量模型显示，AST/ALT比值升高与男性心血管疾病显着相关（FRARISK：HR 1.37，95% CI 1.05 - 1.79; QRISK 2：HR 1.40，95% CI 1.04 - 1.89），但在女性中不存在（风险因子：HR 1.06，95% CI 0.78至1.43; QRISK 2：HR 0.97，95% CI 0.70至1.35）。将AST/ALT比值与所有果糖风险因素（AUC c-统计量：0.72，95% CI 0.71 - 0.74）或QRISK 2风险因素（AUC c-统计量：0.73，95% CI 0.71 - 0.74）一起纳入，与已建立的风险预测工具的区分度无变化。对ALT升高的个体进行的限制性分析表明，FRASANTY和QRISK 2风险因素分别可以提高5%和4%。AST/ALT比值升高与男性发生CVD的风险增加显著相关，但与女性无关。然而，该比率在一般人群中并没有提供任何额外的益处，但在某些亚组中可能具有临床实用性。
Aspartate aminotransferase to alanine aminotransferase (AST/ALT) ratio, reflecting liver disease severity, has been associated with increased risk of cardiovascular disease (CVD). The aim of this study was to evaluate whether the AST/ALT ratio improves established risk prediction tools in a primary care population. Data were analysed from a prospective cohort of 29 316 UK primary care patients, aged 25–84 years with no history of CVD at baseline. Cox proportional hazards regression was used to derive 10-year multivariate risk models for the first occurrence of CVD based on two established risk prediction tools (Framingham and QRISK2), with and without including the AST/ALT ratio. Overall, model performance was assessed by discriminatory accuracy (AUC c-statistic). During a total follow-up of 120 462 person-years, 782 patients (59% men) experienced their first CVD event. Multivariate models showed that elevated AST/ALT ratios were significantly associated with CVD in men (Framingham: HR 1.37, 95% CI 1.05 to 1.79; QRISK2: HR 1.40, 95% CI 1.04 to 1.89) but not in women (Framingham: HR 1.06, 95% CI 0.78 to 1.43; QRISK2: HR 0.97, 95% CI 0.70 to 1.35). Including the AST/ALT ratio with all Framingham risk factors (AUC c-statistic: 0.72, 95% CI 0.71 to 0.74) or QRISK2 risk factors (AUC c-statistic: 0.73, 95% CI 0.71 to 0.74) resulted in no change in discrimination from the established risk prediction tools. Limiting analysis to those individuals with raised ALT showed that discrimination could improve by 5% and 4% with Framingham and QRISK2 risk factors, respectively. Elevated AST/ALT ratio is significantly associated with increased risk of developing CVD in men but not women. However, the ratio does not confer any additional benefits over established CVD risk prediction tools in the general population, but may have clinical utility in certain subgroups.