Association between high-normal levels of alanine aminotransferase and risk factors for atherogenesis

Gastroenterology. 2013 Dec;145(6):1271-9.e1-3. doi: 10.1053/j.gastro.2013.08.036. Epub 2013 Aug 21.


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 < .0001 for all). A high-normal level of ALT was associated with higher levels of LDL-C, LDL-P, sdLDL-C, and sdLDL particles (P < .001 for all). These effects were independent of age, body mass index, and hyperinsulinemia. Increasing levels of ALT and fasting hyperinsulinemia (>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 < .0001 for all).

Conclusions: In an analysis of asymptomatic individuals, increased serum levels of ALT (even high-normal levels) are associated with markers of cardiovascular disease.

Keywords: ALT; Atherosclerosis; BMI; HDL; HDL(INC); HDL-C; HDL2-C; Health Diagnostic Laboratories; Heart Disease; LDL; LDL-C; LDL-P; NAFLD; NASH; TSH; VLDL; VLDL-P; alanine aminotransferase; apoA; apoB; apolipoprotein A; apolipoprotein B; body mass index; high-density lipoprotein; high-density lipoprotein cholesterol; high-density lipoprotein subclass II cholesterol; low-density lipoprotein; low-density lipoprotein cholesterol; low-density lipoprotein particles; nonalcoholic fatty liver disease; sdLDL; small dense low-density lipoprotein; thyroid-stimulating hormone; very-low-density lipoprotein; very-low-density lipoprotein particle.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Alanine Transaminase / blood*
  • Atherosclerosis / blood*
  • Atherosclerosis / epidemiology*
  • Atherosclerosis / physiopathology
  • Biomarkers / blood
  • Body Mass Index
  • Cohort Studies
  • Female
  • Humans
  • Insulin Resistance / physiology
  • Lipoproteins / blood
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Factors


  • Biomarkers
  • Lipoproteins
  • Alanine Transaminase