Ideal cardiovascular health and liver enzyme levels in European adolescents; the HELENA study

J Physiol Biochem. 2017 May;73(2):225-234. doi: 10.1007/s13105-016-0546-9. Epub 2017 Jan 6.


There is an increasing interest for the role of liver enzymes as predictors of non-liver-related morbidity and mortality. The American Heart Association (AHA) described the ideal cardiovascular health concept as a score of seven cardiovascular health behaviors and factors that can be used to monitor and predict ideal cardiovascular health over time. This study aimed to examine the association of the ideal cardiovascular health (ICH), as defined by the AHA, with liver enzyme levels in European adolescents. A total of 637 adolescents (54.6% females), aged 14.6 ± 1.2 years from nine European countries participated in this cross-sectional study. Blood levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyltransferase were measured and the AST/ALT ratio calculated. Ideal cardiovascular health was defined as meeting ideal levels of the following components: four behaviors (smoking, body mass index, physical activity, and diet) and three factors (total cholesterol, blood pressure, and glucose). A higher number of ideal cardiovascular health behaviors, factors, and ideal cardiovascular health index were associated with lower ALT (P < 0.05, P < 0.001, and P < 0.001, respectively) and gamma-glutamyltransferase (P < 0.001, P < 0.01, and P < 0.001, respectively) levels. Similarly, a higher number of ideal cardiovascular health behaviors (P < 0.01), factors (P < 0.01), and ideal cardiovascular health index (P < 0.001) were associated with a higher aspartate aminotransferase to alanine aminotransferase ratio. These findings reinforce the usefulness of the ICH index as an instrument to identify target individuals and promote cardiovascular health in adolescents, and it also extends these observations to the liver manifestation of the metabolic syndrome.

Keywords: Adolescents; Ideal cardiovascular health (ICH); Liver enzymes.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adolescent Health* / ethnology
  • American Heart Association
  • Biomarkers / blood
  • Body Mass Index
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / ethnology
  • Cardiovascular Diseases / physiopathology
  • Cardiovascular Physiological Phenomena*
  • Cohort Studies
  • Cross-Sectional Studies
  • Europe / epidemiology
  • Female
  • Health Status*
  • Healthy Lifestyle*
  • Humans
  • Liver / physiology*
  • Liver / physiopathology
  • Male
  • Metabolic Syndrome / blood
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / ethnology
  • Metabolic Syndrome / physiopathology
  • Pediatric Obesity / blood
  • Pediatric Obesity / epidemiology
  • Pediatric Obesity / ethnology
  • Pediatric Obesity / physiopathology
  • Prevalence
  • Reference Values
  • Risk Factors
  • United States
  • Urban Health* / ethnology


  • Biomarkers