Elevated serum alanine aminotransferase activity and calculated risk of coronary heart disease in the United States

Abstract

In the United States, elevated serum alanine aminotransferase (ALT) activity in the absence of viral hepatitis or excessive alcohol consumption is most commonly attributed to nonalcoholic fatty liver disease (NAFLD). NAFLD is related to predictors of coronary heart disease (CHD) such as insulin resistance and central obesity. We examined the association between elevated serum ALT activity and the 10-year risk of CHD as estimated using the Framingham risk score (FRS). We performed a cross-sectional analysis comparing participants in the Third National Health and Nutrition Examination Survey with normal and elevated ALT activity (>43 IU/L), examining the mean levels of FRS. Among participants without viral hepatitis or excessive alcohol consumption, those with elevated ALT activity (n ‫؍‬ 267) had a higher FRS than those with normal ALT activity (n ‫؍‬ 7,259), both among men (mean difference in FRS 0.25, 95% CI 0.07-0.4; hazard ratio for CHD 1.28, 95% CI 1.07-1.5) and women (mean difference in FRS 0.76, 95% CI 0.4-1.1; hazard ratio for CHD 2.14, 95% CI 1.5-3.0). The ALT threshold for increased risk of CHD was higher in men (>43 IU/L) than in women (>30 IU/L). Elevated ALT activity was not associated with higher FRS among nonobese participants with viral hepatitis or excessive alcohol consumption. In conclusion, individuals with elevated serum ALT activity in the absence of viral hepatitis or excessive alcohol consumption, most of whom have NAFLD, have an increased calculated risk of CHD. This association is more prominent in women.

Liver, Muscle, and Adipose Tissue Insulin Action Is Directly Related to Intrahepatic Triglyceride Content in Obese Subjects

“…There was a 65-fold range in IHTG content (from 0.7% to 45.5%) and a 10-fold range in intraabdominal adipose tissue (IAAT) volume (from 349 cm 3 to 3759 cm 3 ), but only a 2-fold range in percent body fat (from 28% to 52%) and a 1.5-fold range in BMI (from 30 kg/m 2 to 46 kg/ m 2 ) ( Table 1). No significant relationships were detected between IHTG content and BMI (r=0.258, P=0.10) or percent body fat (r=−0.063, P=0.69).…”

Increased risk of cardiovascular disease in non-alcoholic fatty liver disease: causal effect or epiphenomenon?

“…The main cross-sectional [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] and prospective [11,[32][33][34][35][36][37][38][39][40][41][42][43] studies on the association between NAFLD and intermediate markers of CVDor clinical outcomes are shown in Tables 1 and 2 of the Electronic supplementary material. NAFLD, endothelial dysfunction, early carotid atherosclerosis and left ventricular dysfunction NAFLD is associated with circulatory endothelial dysfunction [16,17], a marker of early atherosclerosis. Compared with non-steatotic controls, non-diabetic patients with NAFLD show a significant decrease in brachial artery flow-mediated vasodilation, which is related to the severity of NAFLD histology, independently of age, sex, BMI and HOMA-IR [16].…”

Phosphatidylcholine functional foods and nutraceuticals: A potential approach to prevent non‐alcoholic fatty liver disease

“…Estimates of NASH prevalence range from 2 to 5.7%, but may be found in more than 25% of obese individuals [9]. The link between NAFLD and MetS is clear; in fact, as many as 90% of NAFLD cases have at least one other component of MetS [6]. NAFLD may also be involved with the pathogenesis of CVD.…”

“…In fact, underlying liver pathologies are tightly linked to the pathophysiology of other metabolic abnormalities. The high prevalence of non-alcoholic fatty liver disease (NAFLD) in MetS exhibits the importance of liver health on whole-body physiology [6]. As such, the importance of maintaining optimal liver health as a way of sustaining good health cannot be underestimated.…”