Association between Serum Liver Enzymes and Cardiovascular Diseases: A Case-control Study among Adults with Cardiovascular Disease

Abstract

Introduction: Cardiovascular Diseases (CVDs) are the leading cause of global morbidity and mortality. However, their prevalence is disproportionately distributed, with the highest rate in low-income countries, moderate in middle-income countries, and the lowest in high-income countries. Several studies conducted elsewhere, have identified that certain liver enzymes in serum could predict incident CVDs in adults. Aim: To explore the association between liver enzymes and CVDs in adults. Materials and Methods: This was a hospital-based case-control study conducted at Manipal Teaching Hospital, Pokhara, Kaski, Nepal, from January 2018 to December 2021 among 400 adult subjects (200 healthy controls and 200 CVD patients). Socio-demographic, physiological, and biochemical variables were collected with structured questionnaires and appropriate standardised and validated measurement methods. The p-value (two-tailed) <0.05 was considered statistically significant. Results: The frequency of smoking (p<0.001) and drinking habits (p<0.001), and mean values of Body Mass Index (BMI) (p<0.001), and Systolic Blood Pressure (SBP) (p=0.006), Waist Hip Ratio (WHR), Aspartate Aminotransferases (AST), Alanine Aminotransferases (ALT), Alkaline Phosphatase (ALP), Fasting Blood Sugar (FBS), Glycated Haemoglobin (HbA1c), Creatine Kinase-MB (CK-MB), Troponin I (TpI), Total Cholesterol (TC), and Triglyceride (TG) were significantly higher (p<0.001) in CVD patients than in healthy controls. The High Density Lipoprotein-Cholesterol (HDL-C), on the other hand, was significantly lower in CVD patients. Only the AST showed significant correlation with the cardiac markers CK-MB and TpI. Logistic regression analysis revealed that aminotransferases was the best predictor (due to differences in odd’s ratio) than ALP for incident CVDs in the adult population. Conclusion: Present study verifies that aminotransferases, particularly AST, was significantly associated with the incident CVD and thus, could potentially be measured together with established cardiac biomarkers for the staging and differential diagnosis of CVDs in Nepali adults.

Keywords

• adult population
• alanine aminotransferase
• alkaline phosphatase
• aspartate aminotransferase