Gamma glutamyl transferase as an atherogenic predictive marker in acute coronary syndrome

Background: Acute coronary syndrome (ACS) remains a leading cause of mortality and morbidity world-wide. Atherosclerosis is the predominant cause of ACS and biomarkers that could detect vulnerable atherosclerotic plaque could potentially be of great value in identifying patients at risk of developing coronary events. The aim was to assess the role of gamma-glutamyl transferase (GGT) in atherosclerosis process. The objective was to compare serum levels of GGT in patients with ACS and control subjects, and also to find out the association between GGT and atherogenic risk factors such as diabetes mellitus, hypertension, dyslipidemia and smoking. Methods: The design was a prospective case control study where a total of 151 patients, 100 ACS patients and 51 control subjects with the age group of 30-80 years were enrolled for the study. GGT was estimated by kinetic colour test using Beckman Coulter AU2700 analyser. Results: The mean GGT levels of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA) subgroups were 93.86, 87.87 and 29.27 U/L respectively, which showed statistical significant difference (p<0.001) when compared with control subjects 21.99 U/L. The higher GGT levels in ACS patients also correlated with angiographic diagnosis of atherosclerosis. No significant difference was noted in GGT levels among ACS subgroups having risk factors and without having risk factors.  Conclusions: Significantly higher GGT levels found in ACS patients reflects the burden of atherosclerotic changes and this association implies that GGT estimation can be used as an adjuvant biomarker that may help in identifying patients who are potentially at risk of coronary atherosclerosis.