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Original research
Gamma-glutamyl transferase variability and the risk of hospitalisation for heart failure
  1. So-hyeon Hong1,
  2. Ji Sung Lee2,
  3. Jung A Kim1,
  4. You-Bin Lee1,
  5. Eun Roh1,
  6. Ji Hee Yu1,
  7. Nam Hoon Kim1,
  8. Hye Jin Yoo1,
  9. Ji A Seo1,
  10. Sin Gon Kim1,
  11. Nan Hee Kim1,
  12. Sei Hyun Baik1,
  13. Kyung Mook Choi1
  1. 1 Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
  2. 2 Clinical Research Center, Asan Medical Center, Songpa-gu, Seoul, Korea
  1. Correspondence to Dr Kyung Mook Choi, Internal Medicine, Korea university medical school, Seoul 08308, Korea (the Republic of); medica7{at}


Objective Gamma-glutamyl transferase (GGT) is associated with oxidative stress, inflammation, cardiovascular disease and mortality. Variability in metabolic parameters has recently emerged as an indicator of adverse health outcomes, including heart failure (HF).

Methods We investigated whether GGT variability was associated with the incidence of hospitalisation for heart failure (HHF) in a Korean population without previous HF, ischaemic heart disease or liver disease. This longitudinal cohort study analysed 119 201 individuals from the Korean National Health Insurance Service-National Health Screening Cohort. GGT variability was calculated as the coefficient of variation (CV), SD and variability independent of the mean (VIM).

Results During the 8.4 years of follow-up, 1387 cases of HHF (1.16%) developed. In the multivariable-adjusted model, the HR of HHF was 1.22 (95% CI 1.05 to 1.42) in the highest quartile of GGT variability compared with the lowest quartile, as assessed by CV after adjusting for confounding factors, including alcohol consumption and mean GGT levels. Consistent results were obtained using other indices of GGT variability such as SD (HR 1.37, 95% CI 1.16 to 1.62) and VIM (HR 1.29, 95% CI 1.11 to 1.50). In a subgroup analysis stratified by risk factor variables, although a similar relationship was observed, it was more prominent in individuals with dyslipidaemia.

Conclusions The results of the present study demonstrated that variability in GGT was independently associated with the incidence of HHF. These findings suggest that higher GGT variability may be useful as an indicator of future risk of HF.

  • Heart failure
  • epidemiology
  • cardiac risk factors and prevention

Statistics from


  • S-hH and JSL contributed equally.

  • Contributors Conceptualisation and study design: S-hH, JAK, Y-BL, ER, JHY, NHK, HJY, JAS, SGK, NHK, SHB and KMC. Statistical analysis: JSL. Interpretation of data: JAK, Y-BL and ER. Drafting of the manuscript: S-hH. Obtained funding and critical revision: KMC.

  • Funding This study was supported in part by the Korea University Research Fund (Q1625561, KMC).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Korea University institutional review board (2019GR0122) and National Health Insurance Service (NHIS) review committee (NHIS-2019–20167) and complied with the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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