Effects of Gamma-Glutamyl Transferase on Stroke Occurrence Mediated by Atrial Fibrillation
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Background and Purpose Gamma-glutamyl transferase (GGT) is reported to be associated with stroke independently of the conventional risk factors. However, the underlying mechanism remains to be identified. This study focused on atrial fibrillation (AF), which also reportedly has a close association with GGT. Methods Acute ischemic stroke patients who were admitted to the Seoul National University Hospital within 7 days of stroke onset were analyzed. Multinomial logistic regression was performed to assess the relationship between GGT and cardioembolic stroke. Mediation analysis based on binary logistic regression was used to determine whether AF mediates the relationship between GGT and cardioembolic stroke. Results AF was found in 132 (15.0%) of 880 eligible patients with acute ischemic stroke, and 270 (30.7%) patients were categorized as cardioembolic stroke. High GGT levels in acute ischemic stroke patients was associated with cardioembolic stroke [odds ratio (OR)=3.42, 95% CI=1.59–7.37], but not with large-artery atherosclerosis stroke (OR=1.10, 95% CI=0.54–2.23). Approximately half (53.9%) of the total effect of GGT levels on cardioembolic stroke was mediated by AF. Conclusions The GGT level was significantly associated with cardioembolic stroke via AF. The results obtained in the present study may explain why GGT is associated with stroke.
Abstract
Background and Purpose Gamma-glutamyl transferase (GGT) is reported to be associated with stroke independently of the conventional risk factors. However, the underlying mechanism remains to be identified. This study focused on atrial fibrillation (AF), which also reportedly has a close association with GGT. Methods Acute ischemic stroke patients who were admitted to the Seoul National University Hospital within 7 days of stroke onset were analyzed. Multinomial logistic regression was performed to assess the relationship between GGT and cardioembolic stroke. Mediation analysis based on binary logistic regression was used to determine whether AF mediates the relationship between GGT and cardioembolic stroke. Results AF was found in 132 (15.0%) of 880 eligible patients with acute ischemic stroke, and 270 (30.7%) patients were categorized as cardioembolic stroke. High GGT levels in acute ischemic stroke patients was associated with cardioembolic stroke [odds ratio (OR)=3.42, 95% CI=1.59–7.37], but not with large-artery atherosclerosis stroke (OR=1.10, 95% CI=0.54–2.23). Approximately half (53.9%) of the total effect of GGT levels on cardioembolic stroke was mediated by AF. Conclusions The GGT level was significantly associated with cardioembolic stroke via AF. The results obtained in the present study may explain why GGT is associated with stroke.
참고문헌 (17)
- Wannamethee SG, "The value of gamma-glutamyltransferase in cardiovascular risk prediction in men without diagnosed cardiovascular disease or diabetes", Atherosclerosis, 201, pp.168~175 (2008)
- Strasak AM, "Longitudinal change in serum gamma-glutamyltransferase and cardiovascular disease mortality : a prospective population-based study in 76, 113 Austrian adults", Arterioscler Thromb Vasc Biol, 28, pp.1857~1865 (2008)
- Bots ML, "Gamma-glutamyltransferase and risk of stroke : the EUROSTROKE project", J Epidemiol Community Health, 56(Suppl 1), pp.i25~i29 (2002)
- Ebrahim S, "Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction : Korean national health system prospective cohort study", BMJ, 333, pp.22~ (2006)
- Jousilahti P, "Serum gamma-glutamyl transferase, self-reported alcohol drinking, and the risk of stroke", Stroke, 31, pp.1851~1855 (2000)
- Shimizu Y, "Gamma-glutamyltranspeptidase and incident stroke among Japanese men and women: the Circulatory Risk in Communities Study (CIRCS)", Stroke, 41, pp.385~388 (2010)
- Weikert C, "Liver enzymes and stroke risk in middle-aged German adults", Atherosclerosis, 228, pp.508~514 (2013)
- Yang W, "Gamma-glutamyl transferase predicts future stroke : a Korean nationwide study", Ann Neurol, 83, pp.375~386 (2018)
- Alonso A, "Circulating levels of liver enzymes and incidence of atrial fibrillation : the Atherosclerosis Risk in Communities cohort", Heart, 100, pp.1511~1516 (2014)
- Tekin G, "Serum γ-glutamyltransferase activity in patients with nonvalvular atrial fibrillation", Angiology, 64, pp.157~160 (2013)
- Lee SR, "Association between γ-glutamyltransferase level and incidence of atrial fibrillation : a nationwide population-based study", Int J Cardiol, 245, pp.149~155 (2017)
- Kunutsor SK, "Baseline and long-term gamma-glutamyltransferase, heart failure and cardiac arrhythmias in middle-aged Finnish men : prospective study and pooled analysis of published evidence", Eur J Prev Cardiol, 23, pp.1354~1362 (2016)
- Whitfield JB, "Gamma glutamyl transferase", Crit Rev Clin Lab Sci, 38, pp.263~355 (2001)
- Kunutsor SK, "Gamma glutamyltransferase, alanine aminotransferase and risk of cancer : systematic review and meta-analysis", Int J Cancer, 136, pp.1162~1170 (2015)
- MacKinnon DP, "Estimating mediated effects in prevention studies", Eval Rev, 17, pp.144~158 (1993)
- "Mediation with dichotomous outcomes" (2013)[URL]
- Fox J, "Generalized collinearity diagnostics", J Am Stat Assoc, 87, pp.178~183 (1992)