Elevated serum alanine aminotransferase activity and... : Hepatology (original) (raw)

Liver Failure and Liver Disease: Liver Failure and Liver Disease; Liver Disease

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

Ioannou, George N.1,2,4,*; Weiss, Noel S.6; Boyko, Edward J.1,3,5; Mozaffarian, Dariush7,8,9; Lee, Sum P.1,2,4

1_Research Enhancement Award Program, Veterans Affairs Puget Sound Health Care System, University of Washington Seattle, WA_

2_Division of Gastroenterology, Department of Medicine, University of Washington Seattle, WA_

3_Epidemiologic Research and Information Center, Veterans Affairs Puget Sound Health Care System, University of Washington Seattle, WA_

4_Divisions of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA_

5_Divisions of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA_

6_Department of Epidemiology, University of Washington, Seattle, WA_

7_Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA_

8_Department of Nutrition, Harvard School of Public Health, Boston, MA_

9_Department of Epidemiology, Harvard School of Public Health, Boston, MA_

*Veterans Affairs Puget Sound Health Care System, Division of Gastroenterology, Department of Medicine, S-111-Gastro, 1660 S. Columbian Way, Seattle, WA 98108

Email:[email protected]

Accepted 19 February 2006; Received 25 October 2006

Published online in Wiley InterScience (www.interscience.wiley.com).

Grant sponsor: American College of Gastroenterology Junior Faculty Development Award; Grant sponsor: Primary and Specialty Medical Care Service; Grant sponsor: Research Enhancement Award Program; Grant sponsor: Veterans Affairs Puget Sound Health Care System.

Potential conflict of interest: Nothing to report.

fax: 206-764-2232

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. (Hepatology 2006;43:1145–1151.)