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http://dx.doi.org/10.15324/kjcls.2021.53.3.241

The Relationship between the Serum Aspartate Aminotransferase/Alanine Aminotransferase Ratio and Pulse Pressure in Korean Adults with Hypertension  

Yoon, Hyun (Department of Clinical Laboratory Science, Wonkwang Health Science University)
Publication Information
Korean Journal of Clinical Laboratory Science / v.53, no.3, 2021 , pp. 241-248 More about this Journal
Abstract
The present study was conducted to assess the relationship between aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio and pulse pressure in Korean adults with hypertension. Data from 1,515 adults from the sixth Korean National Health and Nutrition Examination Survey (KNHANES VI-3, 2015) were analyzed. There were several key findings in the present study. First, aspartate aminotransferase (odds ratio [OR], 1.018; 95% confidence interval [CI], 1.002 to 1.033), alanine aminotransferase (OR, 0.982; 95% CI, 0.969 to 0.996), and aspartate aminotransferase/alanine aminotransferase ratio (OR, 1.367; 95% CI, 1.027 to 1.819) were the independent factors determining high pulse pressure. Second, after adjusting for related variables [age, gender, smoking, alcohol consumption, regular exercise, total cholesterol (TC), triglycerides (TGs), high-density lipoprotein-cholesterol (HDL-C), fasting plasma glucose (FPG), body mass index (BMI), and waist circumference (WC)], the ORs of high pulse pressure with the 1st quartile as a reference were significantly higher in the 4th quartile of aspartate aminotransferase/alanine aminotransferase ratio [1.632 (95% CI, 1.113~2.393)]. The high pulse pressure was positively associated with aspartate aminotransferase and alanine aminotransferase/alanine aminotransferase ratio in Korean adults with hypertension, but was inversely associated with alanine aminotransferase.
Keywords
AST/ALT ratio; Hypertension; Pulse pressure;
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1 Yoon H. Association between pulse pressure and impaired pulmonary function in non-smoking adults. Korean J Clin Lab Sci. 2020;52:119-127. https://doi.org/10.15324/kjcls.2020.52.2.119   DOI
2 Ostovaneh MR, Ambale-Venkatesh B, Fuji T, Bakhshi H, Shah R, Murthy VL, et al. Association of liver fibrosis with cardiovascular diseases in the general population: the multi-ethnic study of atherosclerosis (MESA). Circ Cardiovasc Imaging. 2018;11:e007241. https://doi.org/10.1161/CIRCIMAGING.117.007241   DOI
3 Sheth SG, Flamm SL, Gordon FD, Chopra S. AST/ALT ratio predicts cirrhosis in patients with chronic hepatitis C virus infection. Am J Gastroenterol. 1998;93:44-48. https://doi.org/10.1111/j.1572-0241.1998.044_c.x   DOI
4 Vonbank A, Saely C, Rein P, Zanolin D, Leiherer A, Drexel H. The alanine aminotransferase/aspartate aminotransferase ratio predicts future cardiovascular events in patients with established coronary artery disease and homa insulin resistance. Atherosclerosis. 2016;252:e64-65. https://doi.org/10.1016/j.atherosclerosis.2016.07.445   DOI
5 Kucukseymen S, Cekin AH, Bayar N, Arslan S, Uygur Kucukseymen E, Mercan T, et al. A novel biomarker for prediction of atrial fibrillation susceptibility in patients with celiac disease. PLoS One. 2018;13:e0190382. https://doi.org/10.1371/journal.pone.0190382   DOI
6 Su TC, Chien KL, Jeng JS, Chang CJ, Hsu HC, Chen MF, et al. Pulse pressure, aortic regurgitation and carotid atherosclerosis: a comparison between hypertensives and normotensives. Int J Clin Pract. 2006;60:134-140. https://doi.org/10.1111/j.1742-1241.2006.00777.x   DOI
7 Roed T, Kristoffersen US, Knudsen A, Wiinberg N, Lebech AM, Almdal T, et al. Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C-a cross-sectional study. Vasc Health Risk Manag. 2014;10:55-62. https://doi.org/10.2147/VHRM.S53557   DOI
8 White WB. Systolic versus diastolic blood pressure versus pulse pressure. Curr Cardiol Rep. 2002;4:463-467. https://doi.org/10.1007/s11886-002-0107-4   DOI
9 Hallsworth K, Hollingsworth KG, Thoma C, Jakovljevic D, MacGowan GA, Anstee QM, et al. Cardiac structure and function are altered in adults with nonalcoholic fatty liver disease. J Hepatol. 2013;58:757-762. https://doi.org/10.1016/j.jhep.2012.11.015   DOI
10 Kim G, Kim J, Lim YL, Kim MY, Baik SK. Renin-angiotensin system inhibitors and fibrosis in chronic liver disease: a systematic review. Hepatol Int. 2016;10:819-828. https://doi.org/10.1007/s12072-016-9705-x   DOI
11 Fagard RH, Pardaens K, Staessen JA, Thijs L. The pulse pressure-to-stroke index ratio predicts cardiovascular events and death in uncomplicated hypertension. J Am Coll Cardiol. 2001; 38:227-231. https://doi.org/10.1016/s0735-1097(01)01362-6   DOI
12 Botros M, Sikaris KA. The de ritis ratio: the test of time. Clin Biochem Rev. 2013;34:117-130.
13 Rief P, Pichler M, Raggam R, Hafner F, Gerger A, Eller P, et al. The AST/ALT (De-Ritis) ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. Medicine (Baltimore). 2016;95:e3843. https://doi.org/10.1097/MD.0000000000003843   DOI
14 Dart AM, Kingwell BA. Pulse pressure--a review of mechanisms and clinical relevance. J Am Coll Cardiol. 2001;37:975-984. https://doi.org/10.1016/s0735-1097(01)01108-1   DOI
15 Rizzo V, di Maio F, Petretto F, Marziali M, Bianco G, Barilla F, et al. Ambulatory pulse pressure, left ventricular hypertrophy and function in arterial hypertension. Echocardiography. 2004; 21:11-16. https://doi.org/10.1111/j.0742-2822.2004.02146.x   DOI
16 Larstorp AC, Ariansen I, Gjesdal K, Olsen MH, Ibsen H, Devereux RB, et al. Association of pulse pressure with new-onset atrial fibrillation in patients with hypertension and left ventricular hypertrophy: the Losartan Intervention For Endpoint (LIFE) reduction in hypertension study. Hypertension. 2012;60:347-353. https://doi.org/10.1161/HYPERTENSIONAHA.112.195032   DOI
17 Vaccarino V, Berger AK, Abramson J, Black HR, Setaro JF, Davey JA, et al. Pulse pressure and risk of cardiovascular events in the systolic hypertension in the elderly program. Am J Cardiol. 2001;88:980-986. https://doi.org/10.1016/s0002-9149(01)01974-9   DOI
18 Chen Y, Xu M, Wang T, Sun J, Sun W, Xu B, et al. Advanced fibrosis associates with atherosclerosis in subjects with nonalcoholic fatty liver disease. Atherosclerosis. 2015;241:145-150. https://doi.org/10.1016/j.atherosclerosis.2015.05.002   DOI
19 Neves MF, Cunha AR, Cunha MR, Gismondi RA, Oigman W. The role of renin-angiotensin-aldosterone system and its new components in arterial stiffness and vascular aging. High Blood Press Cardiovasc Prev. 2018;25:137-145. https://doi.org/10.1007/s40292-018-0252-5   DOI
20 Seko Y, Kato T, Haruna T, Izumi T, Miyamoto S, Nakane E, et al. Association between atrial fibrillation, atrial enlargement, and left ventricular geometric remodeling. Sci Rep. 2018;8:6366. https://doi.org/10.1038/s41598-018-24875-1   DOI
21 Mantovani A, Zoppini G, Targher G, Golia G, Bonora E. Nonalcoholic fatty liver disease is independently associated with left ventricular hypertrophy in hypertensive type 2 diabetic individuals. J Endocrinol Invest. 2012;35:215-218. https://doi.org/10.1007/BF03345421   DOI
22 Long MT, Pedley A, Massaro JM, Hoffmann U, Fox CS. The association between non-invasive hepatic fibrosis markers and cardiometabolic risk factors in the framingham heart study. PLoS One. 2016;11:e0157517. https://doi.org/10.1371/journal.pone.0157517   DOI
23 Abbas G, Silveira MG, Lindor KD. Hepatic fibrosis and the renin-angiotensin system. Am J Ther. 2011;18:e202-208. https://doi.org/10.1097/MJT.0b013e3181df8df5   DOI
24 Takami T, Shigemasa M. Efficacy of various antihypertensive agents as evaluated by indices of vascular stiffness in elderly hypertensive patients. Hypertens Res. 2003;26:609-614. https://doi.org/10.1291/hypres.26.609   DOI
25 Nyblom H, Bjornsson E, Simren M, Aldenborg F, Almer S, Olsson R. The AST/ALT ratio as an indicator of cirrhosis in patients with PBC. Liver Int. 2006;26:840-845. https://doi.org/10.1111/j.1478-3231.2006.01304.x   DOI
26 Zhao L, Song Y, Dong P, Li Z, Yang X, Wang S. Brachial pulse pressure and cardiovascular or all-cause mortality in the general population: a meta-analysis of prospective observational studies. J Clin Hypertens (Greenwich). 2014;16:678-685. https://doi.org/10.1111/jch.12375   DOI
27 Benetos A, Thomas F, Joly L, Blacher J, Pannier B, Labat C, et al. Pulse pressure amplification a mechanical biomarker of cardiovascular risk. J Am Coll Cardiol. 2010;55:1032-1037. https://doi.org/10.1016/j.jacc.2009.09.061   DOI
28 Gopal DV, Rosen HR. Abnormal findings on liver function tests. Interpreting results to narrow the diagnosis and establish a prognosis. Postgrad Med. 2000;107:100-102,105-109,113-114. https://doi.org/10.3810/pgm.2000.02.869   DOI
29 Glinghammar B, Rafter I, Lindstrom AK, Hedberg JJ, Andersson HB, Lindblom P, et al. Detection of the mitochondrial and catalytically active alanine aminotransferase in human tissues and plasma. Int J Mol Med. 2009;23:621-631. https://doi.org/10.3892/ijmm_00000173   DOI
30 Mazza A, Pessina AC, Gianluca P, Tikhonoff V, Pavei A, Casiglia E. Pulse pressure: an independent predictor of coronary and stroke mortality in elderly females from the general population. Blood Press. 2001;10:205-211. https://doi.org/10.1080/08037050152669710   DOI
31 Fuhrmann V, Jager B, Zubkova A, Drolz A. Hypoxic hepatitis-epidemiology, pathophysiology and clinical management. Wien Klin Wochenschr. 2010;122:129-139. https://doi.org/10.1007/s00508-010-1357-6   DOI
32 Moller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013;34:2804-2811. https://doi.org/10.1093/eurheartj/eht246   DOI
33 Yokoyama M, Watanabe T, Otaki Y, Takahashi H, Arimoto T, Shishido T, et al. Association of the aspartate aminotransferase to alanine aminotransferase ratio with BNP level and cardiovascular mortality in the general population: the yamagata study 10-year follow-up. Dis Markers. 2016;2016:4857917. https://doi.org/10.1155/2016/4857917   DOI
34 Mancusi C, Losi MA, Izzo R, Canciello G, Carlino MV, Albano G, et al. Higher pulse pressure and risk for cardiovascular events in patients with essential hypertension: the campania salute network. Eur J Prev Cardiol. 2018;25:235-243. https://doi.org/10.1177/2047487317747498   DOI
35 Verhave JC, Fesler P, du Cailar G, Ribstein J, Safar ME, Mimran A. Elevated pulse pressure is associated with low renal function in elderly patients with isolated systolic hypertension. Hypertension. 2005;45:586-591. https://doi.org/10.1161/01.HYP.0000158843.60830.cf   DOI
36 Zoppini G, Cacciatori V, Negri C, Stoico V, Lippi G, Targher G, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Medicine (Baltimore). 2016;95:e4821. https://doi.org/10.1097/MD.0000000000004821   DOI
37 Zoppini G, Cacciatori V, Negri C, Stoico V, Lippi G, Targher G, et al. The aspartate aminotransferase-to-alanine aminotransferase ratio predicts all-cause and cardiovascular mortality in patients with type 2 diabetes. Medicine (Baltimore). 2016;95:e4821. https://doi.org/10.1097/MD.0000000000004821   DOI