Clinical

Elevated liver enzymes predict cardiovascular risk in women

Last Updated: 2007-05-23 14:52:23 -0400 (Reuters Health)

By Martha Kerr

WASHINGTON, DC (Reuters Health) - An elevated ratio of alanine transaminase (ALT) to aspartate transaminase (AST) is predictive of coronary atherosclerosis in women, Iranian physicians report.

At Digestive Disease Week 2007, which is being held here this week, Dr. Peyman Adibi of Isfahan University of Medical Sciences, presented the results of an analysis of liver enzyme levels in 630 consecutive male and female patients with suspected coronary atherosclerosis who underwent coronary angiography.

The investigators measured serum AST and ALT concentrations, C-reactive protein levels and assessed features of the metabolic syndrome.

The ALT concentration and ALT/AST ratio were "significantly correlated" with angiographic atherosclerosis score in women but not in men, Dr. Adibi announced. The ALT/AST ratio in women predicted atherosclerosis independent of serum C-reactive protein levels and features of the metabolic syndrome.

The risk of severe coronary artery disease was nearly four-fold higher in women with a high ALT/AST ratio compared with their counterparts with lower levels.

After adjustment for components of the metabolic syndrome, the risk of coronary atherosclerosis was more than five-fold higher in women with elevated liver enzymes. However, the risk was not higher in men with elevated levels of either ALT or AST.

Dr. Adibi pointed out that non-alcoholic fatty liver disease and elevated liver enzymes are associated with components of the metabolic syndrome, including central obesity, high blood pressure, type 2 diabetes and dyslipidemia.

"In patients with proven coronary artery disease, blockage is correlated with fatty liver disease markers," Dr. Adibi told meeting attendees. "But we found this only in women. We are now looking to find out why it is not true in men."

"There are many differences in the causes of coronary disease between men and women. For example, their blood vessels are different," the Iranian investigator told Reuters Health.

An ALT more than twice normal and an ALT/AST ratio greater than 1 is predictive of coronary atherosclerosis, moderator Dr. Jaquellyn J. Maher of the University of California at San Francisco, added after Dr. Adibi's presentation.