Association Between High-Normal Levels of Alanine Aminotransferase and Risk Factors for Atherogenesis

Background & Aims Liver disease has been associated with cardiovascular disorders, but little is known about the relationship between serum levels of alanine aminotransferase (ALT) and markers of atherogenesis. We investigated the relationship between low–normal and high–normal levels of ALT and an extended panel of cardiovascular risk factors among individuals with no known diseases in a primary care setting. Methods We performed a retrospective analysis of data collected from 6442 asymptomatic patients at wellness visits to a primary care setting in central Virginia from 2010 through 2011. Serum levels of ALT were compared with levels of lipids and lipoproteins, as well as metabolic, inflammatory, and coagulation-related factors associated with risk for cardiovascular disease. Results Serum levels of ALT were higher than 40 IU/L in 12% of subjects, and in the high–normal range (19–40 IU/L in women and 31–40 IU/L in men) in 25% of subjects. ALT level was associated with the apolipoprotein B level, concentration and particle size of very-low-density lipoproteins, concentration of low-density lipoprotein (LDL) particles (LDL-P), and percentages of small dense LDL (sdLDL) and sdLDL-cholesterol (sdLDL-C) ( P P 12 μU/mL) synergized with increasing levels of triglycerides, very-low-density lipoprotein particles, LDL-P, sdLDL-C, and percentage of sdLDL-C. Levels of APOA1, high-density lipoprotein-cholesterol, and high-density lipoprotein-class 2 were associated inversely with serum level of ALT ( P Conclusions In an analysis of asymptomatic individuals, increased serum levels of ALT (even high–normal levels) are associated with markers of cardiovascular disease.