Serum transthyretin and aminotransferases are associated with lean mass in people with coronary heart disease: further insights from the CARE-CR study

JAMES, Emily, GOODALL, Stuart, NICHOLS, Simon, WALKER, Karen, CARROLL, Sean, O’DOHERTY, Alasdair F. and INGLE, Lee (2023). Serum transthyretin and aminotransferases are associated with lean mass in people with coronary heart disease: further insights from the CARE-CR study. Frontiers in Medicine, 10.

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Abstract

Background: Low muscle mass disproportionately affects people with coronary heart disease compared to healthy controls but is under-researched and insufficiently treated. Inflammation, poor nutrition, and neural decline might contribute to low muscle mass. This study aimed to assess circulatory biomarkers related to these mechanisms [albumin, transthyretin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and C-terminal agrin fragment] and their relationship with muscle mass in people with coronary heart disease. Our findings could be beneficial to indicate mechanisms of sarcopenia, detect sarcopenia, and evaluate treatment. Methods: Serum blood samples from people with coronary heart disease were analysed for biomarker concentrations using enzyme-linked immunosorbent assays. Skeletal muscle mass was estimated using dual X-ray absorptiometry derived appendicular lean mass and reported as skeletal muscle index (SMI; kg m−2), and as a proportion of total body mass [appendicular skeletal mass (ASM%)]. Low muscle mass was defined as a SMI <7.0 and <6.0 kg m−2, or ASM% <25.72 and <19.43% for men and women, respectively. Associations between biomarkers and lean mass were adjusted for age and inflammation. Results: Sixty-four people were assessed; 14 (21.9%) had low muscle mass. People with low muscle mass had lower transthyretin (effect size 0.34, p = 0.007), ALT (effect size 0.34, p = 0.008), and AST (effect size 0.26, p = 0.037) concentrations, compared to those with normal muscle mass. SMI was associated with inflammation-corrected ALT (r = 0.261, p = 0.039) and with inflammation- and age-adjusted AST/ALT ratio (r = −0.257, p = 0.044). Albumin and C-terminal agrin fragment were not associated with muscle mass indices. Conclusion: Circulatory transthyretin, ALT and AST were associated with low muscle mass in people with coronary heart disease. Low concentrations of these biomarkers might indicate that low muscle mass is partially explained by poor nutrition and high inflammation in this cohort. Targeted treatments to address these factors could be considered for people with coronary heart disease.

Item Type:	Article
Additional Information:	** From Frontiers via Jisc Publications Router ** Licence for this article: http://creativecommons.org/licenses/by/4.0/ ** Peer reviewed: TRUE ** Acknowledgements: We would like to thank Hull and East Riding Cardiac Trust Fund and Northumbria University for providing financial support enabling blood sample analysis. We extend our gratitude to Wendy Summer, Lesley Richardson, and Emma Smith for their support recruiting people to this study. We would also like to thank Julie Davis, Joan Weston and Stella Rimmer for the support they provided during data collection. **Journal IDs: eissn 2296-858X **History: published_online 20-02-2023; accepted 01-02-2023; collection 2023; submitted 10-11-2022
Uncontrolled Keywords:	Medicine, agrin, albumin, aminotransferases, biomarkers, coronary heart disease, muscle, sarcopenia, transthyretin
Identification Number:	https://doi.org/10.3389/fmed.2023.1094733
SWORD Depositor:	Colin Knott
Depositing User:	Colin Knott
Date Deposited:	07 Mar 2023 10:29
Last Modified:	11 Oct 2023 16:46
URI:	https://shura.shu.ac.uk/id/eprint/31615

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