Circulating levels of liver enzymes and incidence of atrial fibrillation

The Atherosclerosis Risk in Communities cohort

Alvaro Alonso, Jeffrey R. Misialek, Mohamed A. Amiin, Ron C. Hoogeveen, Lin Y. Chen, Sunil K. Agarwal, Laura R. Loehr, Elsayed Z. Soliman, Elizabeth Selvin

Research output: Contribution to journalArticle

Abstract

Background: 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. Methods: 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 ã glutamyl transpeptidase (GGT) were measured in stored plasma samples. Incident AF was ascertained from hospitalisations and death certi fi cates. Associations between liver enzymes and AF incidence were assessed using multivariable Cox proportional hazards models. Results: During a mean follow-up of 12 years, 1021 incident AF events were identi fied. 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 in fl ammatory 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. Conclusions: 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.

Original languageEnglish (US)
Pages (from-to)1511-1516
Number of pages6
JournalHeart
Volume100
Issue number19
DOIs
StatePublished - 2014

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Atrial Fibrillation
Atherosclerosis
Liver
Incidence
Enzymes
Aspartate Aminotransferases
Alanine Transaminase
gamma-Glutamyltransferase
Proportional Hazards Models
Hospitalization
Cardiovascular Diseases
Heart Failure
Alcohols
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Circulating levels of liver enzymes and incidence of atrial fibrillation : The Atherosclerosis Risk in Communities cohort. / 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.

In: Heart, Vol. 100, No. 19, 2014, p. 1511-1516.

Research output: Contribution to journalArticle

Alonso, A, Misialek, JR, Amiin, MA, Hoogeveen, RC, Chen, LY, Agarwal, SK, Loehr, LR, Soliman, EZ & Selvin, E 2014, 'Circulating levels of liver enzymes and incidence of atrial fibrillation: The Atherosclerosis Risk in Communities cohort', Heart, vol. 100, no. 19, pp. 1511-1516. https://doi.org/10.1136/heartjnl-2014-305756
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. / Circulating levels of liver enzymes and incidence of atrial fibrillation : The Atherosclerosis Risk in Communities cohort. In: Heart. 2014 ; Vol. 100, No. 19. pp. 1511-1516.
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abstract = "Background: 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. Methods: 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 {\~a} glutamyl transpeptidase (GGT) were measured in stored plasma samples. Incident AF was ascertained from hospitalisations and death certi fi cates. Associations between liver enzymes and AF incidence were assessed using multivariable Cox proportional hazards models. Results: During a mean follow-up of 12 years, 1021 incident AF events were identi fied. 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 in fl ammatory 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. Conclusions: 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.",
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T1 - Circulating levels of liver enzymes and incidence of atrial fibrillation

T2 - The Atherosclerosis Risk in Communities cohort

AU - Alonso, Alvaro

AU - Misialek, Jeffrey R.

AU - Amiin, Mohamed A.

AU - Hoogeveen, Ron C.

AU - Chen, Lin Y.

AU - Agarwal, Sunil K.

AU - Loehr, Laura R.

AU - Soliman, Elsayed Z.

AU - Selvin, Elizabeth

PY - 2014

Y1 - 2014

N2 - Background: 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. Methods: 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 ã glutamyl transpeptidase (GGT) were measured in stored plasma samples. Incident AF was ascertained from hospitalisations and death certi fi cates. Associations between liver enzymes and AF incidence were assessed using multivariable Cox proportional hazards models. Results: During a mean follow-up of 12 years, 1021 incident AF events were identi fied. 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 in fl ammatory 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. Conclusions: 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.

AB - Background: 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. Methods: 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 ã glutamyl transpeptidase (GGT) were measured in stored plasma samples. Incident AF was ascertained from hospitalisations and death certi fi cates. Associations between liver enzymes and AF incidence were assessed using multivariable Cox proportional hazards models. Results: During a mean follow-up of 12 years, 1021 incident AF events were identi fied. 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 in fl ammatory 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. Conclusions: 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.

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DO - 10.1136/heartjnl-2014-305756

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