Association Between AST to ALT Ratio and Peripheral Artery Disease in Chinese Hypertensive Population: A Cross-Sectional Study

Abstract

Background: Previous studies had shown the role of aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT) in cardiovascular disease . Peripheral artery disease(PAD) is an important risk factor for cardiovascular death. However, there are fewer investigations of the correlations between the AST/ALT ratio and Peripheral artery disease (PAD). Methods: We analyzed data of 10,900 hypertensive patients from the Chinese Hypertension Registry Study. Using a multivariate logistic regression model, we examined the association between AST / ALT and peripheral arterial disease (PAD),which was defined as ABI≤ 0.9 in either leg.Results：A total of 350 patients had peripheral arterial disease and the prevalence of PAD was 3.21%. After adjusting for potential confounders, AST / ALT ratio was independently and positively associated with risk of PAD (OR: 1.31, 95% CI: 1.13 to 1.59), and a statistically significant increased risk of PAD for the third AST / ALT ratio tertile (T3) compared to the first tertile (T1) (OR:1.49, 95% CI: 1.09 to 2.04, P-trend= 0.005) was found. Moreover, when we combined T1-T2 into one group and used it as a reference group, the risk of PAD increased with the increase of AST/ALT and the risk ratio was 1.52 (95% CI :1.20 to 1.95). Conclusion: A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. Our results suggested that AST / ALT maybe help us highlight patients who was at high risk of vascular endpoints.Trial registration: CHICTR, CHiCTR1800017274. Registered 20 July 2018.

AST to ALT Ratio and Peripheral Arterial Disease in a Hypertensive Population—Is There a Link?

“…In this issue of Angiology, Liu et al 1 examine the association between the aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio and the prevalence of peripheral arterial disease (PAD) in participants of the Chinese Hypertension Registry Study (n ¼ 10 900 patients with hypertension, mean age 63.86 + 9.25 years, 47.06% male). Using the anklebrachial index as an indicator of the presence of arterial insufficiency, the authors 1 identified 350 patients with PAD (prevalence: 3.21%).…”

“…The authors 1 observed that the AST/ALT ratio was positively and independently associated with the risk of PAD (odds ratio [OR]: 1.31, 95% CI: 1.13-1.59), noting a significant increased risk of PAD for those in T3 versus T1 (OR: 1.49, 95% CI: 1.09-2.04, P ¼ .005); by combining T1 and T2 (as a single reference group), the risk of PAD was positively associated with higher AST/ALT ratio, yielding a risk ratio of 1.52 (95% CI: 1.20-1.95). 1 They 1 concluded that an AST/ALT ratio !1.65 is associated with PAD risk and that it could help identify patients at high risk of vascular events.…”

“…1 They 1 concluded that an AST/ALT ratio !1.65 is associated with PAD risk and that it could help identify patients at high risk of vascular events. 1 The authors 1 considered several explanations for their findings: the increased risk of developing PAD in patients with an elevated AST/ALT ratio could lie in the coexistence of nonalcoholic fatty liver disease (NAFLD), with its propensity to exacerbate dyslipidemia; patients with an elevated AST/ALT ratio may exhibit insulin resistance (IR), which has been strongly linked with vascular risk and PAD. However, they suggest that such associations are insufficient to explain the observed interrelation, and other mechanisms linking PAD and AST/ALT merit consideration.…”

“…However, they suggest that such associations are insufficient to explain the observed interrelation, and other mechanisms linking PAD and AST/ALT merit consideration. 1 Cardiovascular (CV) risk factors (RFs) are associated with an increased risk for the development of arterial disease in all vascular beds but differ in their individual impacts for each vascular bed. 2,3 Peripheral arterial disease may coexist with coronary artery disease (CAD), carotid artery disease, and abdominal aortic aneurysms.…”