The relationship between liver enzymes in the blood test and non-fatal cardiovascular disease events: a systematic review and meta-analysis

BACKGROUND: In recent years, interest in the potential of liver enzymes has increased to serve as markers for cardiovascular disease (CVD) risk. This systematic review and meta-analysis aimed to examine the relationship between liver enzymes in blood tests and non-fatal cardiovascular disease events, focusing on retrospective and prospective cohort studies. METHODS: A methodical search was carried out across several academic databases, including Scopus, PubMed, and Web of Science. Relevant keywords were identified and categorized into two groups. Two reviewers independently reviewed the obtained papers to recognize related studies. Then, the authors independently gathered the necessary information. The quality of the papers was evaluated using the Newcastle-Ottawa Scale (NOS). Moreover, a meta-analysis was also performed on the values of the hazard ratio and odds ratio reported in some studies. RESULTS: 36 articles were entered into the study. Most of the studies (89.3 percent) showed that there are positive significant relationships between gamma-glutamyl transferase (GGT) enzyme and non-fatal cardiovascular disease events. While only 50.0 percent of the studies on alanine aminotransferase (ALT) and 66.7 percent of the papers on aspartate aminotransferase (AST) revealed a positive significant association with non-fatal cardiovascular disease events. The pooled value of the hazard ratio related to the GGT, ALT, and AST levels for non-fatal cardiovascular disease events was computed by 1.28 (95% CI: 1.21-1.36), 1.23 (95%CI: 1.07-1.42), and 1.35 (95%CI: 1.17-1.55). CONCLUSIONS: There is a strong agreement on GGT for diagnosing cardiovascular diseases. These results can be applied as guidance for the diagnosis of cardiovascular diseases using liver enzymes as routine blood tests.