Abstract Body (Do not enter title and authors here): Introduction: Increased aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT ratio) has recently been reported to be associated with all-cause and cardiovascular disease (CVD) mortality; however, its association with CVD events remains unclear.
Research Question: Can the AST/ALT ratio predict CVD events in diabetic patients without a history of CVD?
Aim: To investigate if the AST/ALT ratio is associated with future CVD in diabetic patients without known CVD but at high risk for it.
Methods: Data form the EMPATHY study, which compared intensive and standard statin therapy in patients with type 2 diabetes mellitus (T2DM), diabetic retinopathy, and hyperlipidemia without known CVD, were used. Patients were divided into two groups based on a baseline AST/ALT ratio cut-off of 1.0, in accordance with previous reports, and the association with CVD events was analyzed.
Results: A total of 4871 patients were divided into high (>1.0, n=2414) and low (≤1.0, n=2457) AST/ALT ratio groups. During a median follow-up of 36.7 months, 261 CVD events occurred. The cumulative incidence of CVD was significantly higher in the high AST/ALT group compared to the low AST/ALT group (P=0.008, log-rank test) (Fig. A). Multivariate Cox regression analysis showed that a high AST/ALT ratio was significantly associated with increased risk of CVD compared to a low AST/ALT ratio (HR, 1.36 [95% CI, 1.04–1.79], P=0.002). This significant association was also observed when analyzing the AST/ALT ratio as a continuous variable, consistent with the restricted cubic spline curve analysis (Fig. B). The association of a high AST/ALT with CVD events was similar in subgroups stratified by sex, age, body mass index, and hemoglobin A1c (Fig. C).
Conclusion: Increased AST/ALT ratio was significantly associated with the risk of CVD in patients with T2DM, diabetic retinopathy, and hyperlipidemia without a history of CVD, suggesting its usefulness as a predictor of CVD events in these patients.