Journal
DIABETOLOGIA
Volume 58, Issue 7, Pages 1484-1493Publisher
SPRINGER
DOI: 10.1007/s00125-015-3575-y
Keywords
Cardiovascular diseases; Community-based; Epidemiology; Fatty liver; gamma-Glutamyltransferase; Type 2 diabetes mellitus
Categories
Funding
- UK Medical Research Council
- Chief Scientist Office for Scotland
- Pfizer
- Peviva
- Diabetes UK Clinical Research Fellowship
- Academy of Medical Sciences (AMS) [AMS-CSF3-Fallowfield] Funding Source: researchfish
- Diabetes UK [10/0003985] Funding Source: researchfish
- Medical Research Council [G0500877, G84/6205] Funding Source: researchfish
- MRC [G84/6205, G0500877] Funding Source: UKRI
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Aims/hypothesis We examined the association of prevalent and incident cardiovascular disease (CVD) with chronic liver disease in a cohort of community-based people with type 2 diabetes, in order to clarify the relationship between these two important conditions. Methods 1,066 participants with type 2 diabetes aged 60-75 years underwent assessment of a range of liver injury markers (non-specific injury, steatosis, steatohepatitis, fibrosis, portal hypertension). Individuals were followed up for incident cardiovascular events. Results At baseline there were 370/1,033 patients with prevalent CVD, including 317/1,033 with coronary artery disease (CAD). After a mean follow-up of 4.4 years there were 44/663 incident CVD events, including 27/663 CAD events. There were 30/82 CVD-related deaths. Risk of dying from or developing CVD was no higher in participants with steatosis than in those without (HR 0.90; 95% CI 0.40, 2.00; p > 0.05). The only notable relationship was with gamma-glutamyltransferase (GGT) (incident CVD: adjusted HR for doubling GGT 1.24 [95% CI 0.97, 1.59] p = 0.086; incident CAD: adjusted HR 1.33 [95% CI 1.00, 1.78] p = 0.053), suggesting that in our study population, chronic liver disease may have little effect on the development of, or mortality from, CVD. Conclusions/interpretation An independent association between GGT and CVD warrants further exploration as a potentially useful addition to current cardiovascular risk prediction models in diabetes. However, overall findings failed to suggest that there is a clinical or pathophysiological association between chronic liver disease and CVD in elderly people with type 2 diabetes.
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