Research has investigated the gamma-glutamyltransferase to high-density lipoprotein cholesterol (GGT/HDL-C) ratio concerning metabolic diseases. This study aims to explore its effects on mortality, including cardiovascular disease (CVD) mortality.

A retrospective cohort study was conducted utilizing data from the National Health and Nutrition Examination Survey (1999-2018), comprising 50,462 U.S. adults. Survival outcomes were assessed through Kaplan-Meier curves, and a multivariable Cox proportional hazards model was employed to analyze the relationship between GGT/HDL-C levels and mortality risk. Restricted cubic splines and hierarchical analyses were utilized to explore potential non-linear associations and interactions, respectively.

During a median follow-up period of 114.4 months, 7573 deaths were recorded, including 1956 deaths related to CVD. The relationship between the GGT/HDL-C ratio and the likelihood of all-cause death and CVD death showed a J-shaped curve in the restricted cubic spline analysis. Below a lnGGT/HDL-C of 2.3 (GGT/HDL-C of 10.0), no significant correlation with all-cause mortality was identified, while the threshold for CVD death was established at lnGGT/HDL-C of 2.5. Beyond these thresholds, each unit increase in lnGGT/HDL-C was associated with a 36.3 % higher risk of all-cause mortality [HR (95 % CI), 1.36 (1.26, 1.47)] and a 67.1 % increased risk of death from CVD [HR (95 % CI), 1.67 (1.42, 1.97)]. Consistent findings were observed across various subgroups, with participants younger than 65 showing a more pronounced association.

The GGT/HDL-C ratio exhibits a J-shaped correlation with the risk of all-cause mortality and CVD mortality among U.S. adults. This ratio may be utilized for assessing mortality risk.

To explore the association between gamma-glutamyltransferase (GGT) and in-hospital heart failure (HF) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

A total of 412 patients diagnosed with STEMI and treated with primary PCI were included in our study. Univariate and multivariate logistic regression models were used to evaluate the association between GGT and the risk of in-hospital HF in STEMI patients. The receiver operating characteristic (ROC) curve was used to assess the accuracy of GGT in predicting in-hospital HF.

The incidence of HF after STEMI increased significantly with increasing GGT tertiles (the first, second, and third tertile groups were 7.97%, 14.49%, and 18.38%, respectively; p = 0.039). Multivariate logistic regression analysis revealed that the risk of HF in the second and third GGT tertile groups was 2.51 times greater (95% CI, 1.06-5.96) and 2.77 times greater (95% CI, 1.13-6.81), respectively, than that in the first GGT tertile group. Each 1-unit increase in the lnGGT level was related to a 1.88-fold increased risk of HF (odds ratio, OR, 1.88; 95% CI, 1.19-2.96; p = 0.007). Restricted cubic splines suggested a linear relationship between GGT and in-hospital HF (p for nonlinearity = 0.158). The area under the curve was 0.607 (95% CI, 0.558-0.654; p = 0.007) when GGT was used to predict in-hospital HF, with a sensitivity of 57.14% and a specificity of 64.04%. Moreover, the incidence of HF significantly increased in-hospital death risk (OR, 7.75; 95% CI, 1.87-32.12; p = 0.005).

GGT is positively associated with in-hospital HF and is an independent risk factor for in-hospital HF in STEMI patients.

This editorial synthesizes insights from a series of studies examining the interplay between metabolic and oxidative stress biomarkers in cardiovascular disease (CVD), focusing particularly on type-2 diabetes mellitus (T2DM) and acute coronary syndrome (ACS). The central piece of this synthesis is a study that investigates the balance between oxidative stress and antioxidant systems in the body through the analysis of serum bilirubin and γ-glutamyltranspeptidase (γ-GGT) levels in T2DM patients with ACS. This study highlights serum bilirubin as a protective antioxidant factor, while elevated γ-GGT levels indicate increased oxidative stress and correlate with major adverse cardiovascular events. Complementary to this, other research contributions reveal γ-GGT's role as a risk factor in ACS, its association with cardiovascular mortality in broader populations, and its link to metabolic syndrome, further elucidating the metabolic dysregulation in CVDs. The collective findings from these studies underscore the critical roles of γ-GGT and serum bilirubin in cardiovascular health, especially in the context of T2DM and ACS. By providing a balanced view of the body's oxidative and antioxidative mechanisms, these insights suggest potential pathways for targeted interventions and improved prognostic assessments in patients with T2DM and ACS. This synthesis not only corroborates the pivotal role of γ-GGT in cardiovascular pathology but also introduces the protective potential of antioxidants like bilirubin, illuminating the complex interplay between T2DM and heart disease. These studies collectively underscore the critical roles of serum bilirubin and γ-GGT as biomarkers in cardiovascular health, particularly in T2DM and ACS contexts, offering insights into the body's oxidative and antioxidative mechanisms. This synthesis of research supports the potential of these biomarkers in guiding therapeutic strategies and improving prognostic assessments for patients with T2DM and some CVD.