Correlation between serum gamma glutamyl transferase with atherogenic index of plasma with angiographic severity in patients with coronary artery disease
DOI:
https://doi.org/10.15584/ejcem.2025.2.12Keywords:
angiographic severity, atherogenic index of plasma, coronary artery disease, gensini score, serum gamma-glutamyl transferaseAbstract
Introduction and aim. Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Gamma-glutamyl transferase (GGT) has been found to be involved in the pathogenesis of CAD. The aim of the study was to study the correlation between serum GGT and the atherogenic index of plasma (AIP) with angiographic severity in patients with CAD.
Material and methods. This was an analytical cross-sectional study performed in 150 CAD patients in a tertiary-care teaching hospital in Puducherry, India. The patients were categorized as ST-elevated myocardial infarction (STEMI), non-ST-elevated MI (NSTEMI) and unstable angina. Routine biomarkers including troponin-I, AIP, GGT, and angiographic severity were calculated by applying a Gensini score (GS).
Results. The mean age of the study participants was 55.7±10.2 years, predominantly males. The GGT and GS was higher in STEMI group followed by NSTEMI and unstable angina groups (p<0.001 and 0.016, respectively). This indicates that GGT could be a potential biomarker for CAD, specifically in STEMI. AIP was shown to be statistically significant in unstable angina patients (p=0.029). GGT and GS showed a positive correlation with each other, and were statistically significant (r=0.1685, p=0.0387).
Conclusion. Elevated serum GGT levels were positively correlated with angiographic severity of CAD with stronger associations in patients who had STEMI.
Downloads
References
Global health estimates: Leading causes of death. https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-leading-causes-of-death. Accessed January 20, 2024.
Prabhakaran D, Jeemon P, Roy A. Cardiovascular Diseases in India: Current Epidemiology and Future Directions. Circulation. 2016;133(16):1605-1620. doi: 10.1161/CIRCULATIONAHA.114.008729
Iyengar SS, Gupta R, Ravi S, et al. Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry. Indian Heart J. 2017;69(2):211-216. doi: 10.1016/j.ihj.2016.09.009
Sreeniwas Kumar A, Sinha N. Cardiovascular disease in India: A 360 degree overview. Med J Armed Forces India. 2020;76(1):1-3. doi: 10.1016/j.mjafi.2019.12.005
Schiele F, Ecarnot F, Chopard R. Coronary artery disease: Risk stratification and patient selection for more aggressive secondary prevention. Eur J Prev Cardiol. 2017;24(3):88-100. doi: 10.1177/2047487317706586
Emdin M, Pompella A, Paolicchi A. Gamma-glutamyltransferase, atherosclerosis, and cardiovascular disease: triggering oxidative stress within the plaque. Circulation. 2005;112(14):2078-2080. doi: 10.1161/CIRCULATIONAHA.105.571919
Danesh J, Collins R, Appleby P, et al. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998;279(18):1477-1482. doi: 10.1001/jama.279.18.1477
Pleiner J, Mittermayer F, Schaller G, et al. Inflammation-induced vasoconstrictor hyporeactivity is caused by oxidative stress. J Am Coll Cardiol. 2003;42(9):1656-1662. doi: 10.1016/j.jacc.2003.06.002
Alissa EM. Relationship between serum gamma-glutamyltransferase activity and cardiometabolic risk factors in metabolic syndrome. J Fam Med Prim Care. 2018;7(2):430-434. doi: 10.4103/jfmpc.jfmpc_194_17
Targher G. Elevated serum gamma-glutamyltransferase activity is associated with increased risk of mortality, incident type 2 diabetes, cardiovascular events, chronic kidney disease and cancer - a narrative review. Clin Chem Lab Med. 2010;48(2):147-157. doi: 10.1515/CCLM.2010.031
Ndrepepa G, Kastrati A. Gamma-glutamyl transferase and cardiovascular disease. Ann Transl Med. 2016;4(24):481. doi: 10.21037/atm.2016.12.27
Sheikh M, Tajdini M, Shafiee A, et al. Association of serum gamma-glutamyltransferase and premature coronary artery disease. Neth Heart J. 2017;25(7-8):439-445. doi: 10.1007/s12471-017-0964-5
Wannamethee G, Ebrahim S, Shaper AG. Gamma-glutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol. 1995;142(7):699-708. doi: 10.1093/oxfordjournals.aje.a117699
Breitling LP, Grandi NC, Hahmann H, et al. Gamma-glutamyltransferase and prognosis in patients with stable coronary heart disease followed over 8 years. Atherosclerosis. 2010;210(2):649-655. doi: 10.1016/j.atherosclerosis.2009.12.037
Aksakal E, Tanboga IH, Kurt M, et al. The relation of serum gamma-glutamyl transferase levels with coronary lesion complexity and long-term outcome in patients with stable coronary artery disease. Atherosclerosis. 2012;221(2):596-601. doi: 10.1016/j.atherosclerosis.2012.01.044
Yang P, Wu P, Liu X, et al. Association Between γ-Glutamyltransferase Level and Cardiovascular or All-Cause Mortality in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis. Angiology. 2019;70(9):844-852. doi: 10.1177/0003319719850058
Long Y, Zeng F, Shi J, et al. Gamma-glutamyltransferase predicts increased risk of mortality: a systematic review and meta-analysis of prospective observational studies. Free Radic Res. 2014;48(6):716-728. doi: 10.3109/10715762.2014.902055
Du G, Song Z, Zhang Q. Gamma-glutamyltransferase is associated with cardiovascular and all-cause mortality: a meta-analysis of prospective cohort studies. Prev Med. 2013;57(1):31-37. doi: 10.1016/j.ypmed.2013.03.011
Evans JL, Goldfine ID, Maddux BA, et al. Oxidative stress and stress-activated signaling pathways: a unifying hypothesis of type 2 diabetes. Endocr Rev. 2002;23(5):599-622. doi: 10.1210/er.2001-0039
Zambon A, Pauletto P, Crepaldi G. Review article: the metabolic syndrome--a chronic cardiovascular inflammatory condition. Aliment Pharmacol Ther. 2005;22(2):20-23. doi: 10.1111/j.1365-2036.2005.02589.x
Lee DH, Blomhoff R, Jacobs DR. Is serum gamma glutamyltransferase a marker of oxidative stress? Free Radic Res. 2004;38(6):535-539. doi: 10.1080/10715760410001694026
Cho YK, Kang YM, Hwang JY, et al. Association between serum gamma-glutamyltransferase and the progression of coronary artery calcification. Atherosclerosis. 2015;243(1):300-306. doi: 10.1016/j.atherosclerosis.2015.09.027
Jousilahti P, Rastenyte D, Tuomilehto J. Serum gamma-glutamyl transferase, self-reported alcohol drinking, and the risk of stroke. Stroke. 2000;31(8):1851-1855. doi: 10.1161/01.str.31.8.1851
Lee DS, Evans JC, Robins SJ, et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol. 2007;27(1):127-133. doi: 10.1161/01.ATV.0000251993.20372.40
Indian Council of Medical Research, Public Health Foundation of India, and Institute for Health Metrics and Evaluation. India: Health of the Nation’s States – the India state-level disease burden initiative. New Delhi, India: ICMR, PHFI, and IHME; 2017. https://www.healthdata.org/sites/default/files/files/policy_report/2017/India_Health_of_the_Nation%27s_States_Report_2017.pdf. Accessed November 20, 2024.
Niroumand S, Khajedaluee M, Khadem-Rezaiyan M, et al. Atherogenic Index of Plasma (AIP): A marker of cardiovascular disease. Med J Islam Repub Iran. 2015;29:240.
Rampidis GP, Benetos G, Benz DC, et al. A guide for Gensini Score calculation. Atherosclerosis. 2019;287:181-183. doi: 10.1016/j.atherosclerosis.2019.05.012
Xavier D, Pais P, Devereaux PJ, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet Lond Engl. 2008;371(9622):1435-1442. doi: 10.1016/S0140-6736(08)60623-6
Jose VJ, Gupta SN. Mortality and morbidity of acute ST segment elevation myocardial infarction in the current era. Indian Heart J. 2004;56(3):210-214.
Holay MP, Janbandhu A, Javahirani A, et al. Clinical profile of acute myocardial infarction in elderly (prospective study). J Assoc Physicians India. 2007;55:188-192.
Paolicchi A, Minotti G, Tonarelli P, et al. Gamma-glutamyl transpeptidase-dependent iron reduction and LDL oxidation-a potential mechanism in atherosclerosis. J Investig Med. 1999;47(3):151-160.
Hanigan MH. Gamma-Glutamyl Transpeptidase: Redox Regulation and Drug Resistance. Adv Cancer Res. 2014;122:103-141. doi: 10.1016/B978-0-12-420117-0.00003-7
Belcastro E. Inflammation and oxidative stress in atherosclerosis: role of S-nitrosothiols in the vascular responses. Human health and pathology. Université de Lorraine, 2016.
Kittleson MM, Patel JK, Kobashigawa JA. CARDIAC TRANSPLANTATION. In: Fuster V, Harrington RA, Narula J, Eapen ZJ, editors. Hurst’s The Heart [Internet]. 14Th ed. New York, NY: McGraw-Hill Education; 2017. Available from: https://accessmedicine.mhmedical.com/content.aspx?bookid=2046§ionid=176562189&jumpsectionID=185757122. Accessed November 20, 2024.
Arasteh S, Moohebati M, Avan A, et al. Serum level of gamma-glutamyl transferase as a biomarker for predicting stenosis severity in patients with coronary artery disease. Indian Heart J. 2018;70(6):788-792. doi: 10.1016/j.ihj.2017.11.017
Ruttmann E, Brant LJ, Concin H, et al. Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation. 2005;112(14):2130-2137. doi: 10.1161/CIRCULATIONAHA.105.552547
Kunutsor SK, Bakker SJL, Kootstra-Ros JE, et al. Circulating gamma glutamyltransferase and prediction of cardiovascular disease. Atherosclerosis. 2015;238(2):356-364. doi: 10.1016/j.atherosclerosis.2014.12.045
Baktir AO, Sarli B, Demirci E, et al. γ-Glutamyl transferase activity and the burden of coronary atherosclerosis in patients with ST-segment elevation myocardial infarction. Angiology. 2014;65(9):812-816. doi: 10.1177/0003319713507475
Mao Y, Qi X, Xu W, et al. Serum gamma-glutamyl transferase: A novel biomarker for coronary artery disease. Med Sci Monit Int Med J Exp Clin Res. 2014;20:706-710. doi: 10.12659/MSM.890245
Hartopo AB, Arso IA, Setianto BY. Low Plasma Atherogenic Index Associated with Poor Prognosis in Hospitalized Patients with Acute Myocardial Infarction. Acta Medica Indones. 2016;48(2):106-113.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
