title: Predictive Value of Biochemical Markers on Incident Cardiometabolic Disease in a Population of Older Community-Dwelling Chinese Adults
Creators: name: Zhang, Yuming
Publisher: name: Griffith University
Year: 2023
Subjects: subject: cardiometabolic disease
subject: aspartate aminotransferase
subject: inorganic phosphate
subject: cohort

description: Chronic diseases have become one of the leading causes of death in recent years and continues to evolve globally. A large proportion of disease burden is attributed to cardiovascular and metabolic diseases such as ischaemic heart disease, hypertension, heart failure, type-2 diabetes mellitus, metabolic syndrome and chronic renal failure, collectively termed cardiometabolic disease (CMD). Effective prevention and early detection of CMD are essential to reduce morbidity, mortality, and lower the associated cost of health care. This is particularly important for at-risk populations such as older adults, who demonstrate greater prevalence and mortality from CMD compared to younger populations. Previous studies have explored the predictive role of traditional biochemical markers on CMD development among various populations. However, the evidence for some markers remains heterogenous. Furthermore, few studies have examined the older Chinese population, which is a major contributor to the CMD burden in East Asia. Using a cohort of community-dwelling older adults in China, this research aimed to investigate the predictive role of traditional biochemical markers, namely hepatic aminotransferases and inorganic phosphate, on the development of incident CMD. Secondary data analysis was performed with data collected by Professor Sun’s research team at the Shanghai East Hospital from 2014 to 2017. Using a combination of quantitative and qualitative approach, biological, biochemical and behavioural data were collected at baseline and follow-up. Bivariate and correlation analyses were conducted to determine demographic factors associated with disease outcome and quantify the correlation between baseline biochemical factors. Cox regression analysis was used to examine the association between baseline aminotransferase, inorganic phosphate and incident CMD development. The study findings confirmed that both hepatic aminotransferases and inorganic phosphate levels at baseline were independently associated with the development of metabolic disease, including type-2 diabetes mellitus and metabolic syndrome. However, cardiovascular diseases such as ischaemic heart disease, hypertension and heart failure were unrelated to baseline aminotransferase and inorganic phosphate. Compared to disease-free subjects, subjects who developed CMD were more likely to earn higher income. Similarly, diseased subjects were less likely to work physical jobs such as farming, and more likely to work in offices. Sex, smoking status, alcohol drinking and exercise statuses showed no significant difference. Cox regression analysis suggested greater aminotransferases at baseline were associated with increased risks of developing type-2 diabetes mellitus. This association was independent of covariates, unlike metabolic syndrome which became attenuated in the multi-adjusted model. At baseline, aminotransferases demonstrated high intercorrelation with each other and differential correlation with other risk factors. Higher alanine aminotransferase (ALT) concentration was associated with greater waist circumference, triglyceride, fasting glucose and HbA1c. It was also negatively correlated with protective factors such as HDL. Higher inorganic phosphate quartile in women was associated with greater risks of developing type-2 diabetes but lower risks of developing metabolic syndrome. Higher quartiles of inorganic phosphate at baseline showed gender-specific associations with risk factors. In men, it was associated with smoking, higher blood pressure and glycaemic profile. In women, higher inorganic phosphate was associated with protective factors such as lower BMI, waist circumference and blood pressure. In conclusion, this research demonstrated the predictive role of traditional biochemical markers, namely hepatic aminotransferases and inorganic phosphate, in the development of incident metabolic disease. Based on findings of this study, it is recommended that AST, ALT and inorganic phosphate measurements be considered in stratifying metabolic risk and identifying high-risk individuals among the older community-dwelling Chinese population.