Epidemiology

Heart disease risk is increased with nonalcoholic fatty liver disease

Last Updated: 2006-05-09 15:00:48 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Patients with elevated serum alanine aminotransferase (ALT) levels not related to viral hepatitis or alcohol abuse have an increased risk of coronary heart disease (CHD), according to findings published in the May issue of Hepatology.

"In the United States, elevated serum ALT activity in the absence of viral hepatitis or excessive alcohol consumption is most commonly attributed to nonalcoholic fatty liver disease (NAFLD)," Dr. George N. Ioannou, of the University of Washington, Seattle, and colleagues note. "NAFLD is related to predictors of CHD such as insulin resistance and central obesity."

The researchers compared subjects in the Third National Health and Nutrition Examination Survey with normal and elevated ALT activity (greater than 43 IU/L), examining the mean levels of the Framingham risk score (FRS) for coronary heart disease.

Of the 7526 subjects without viral hepatitis or excessive alcohol consumption, 267 had elevated ALT activity and 7259 had normal ALT activity. Patients with elevated ALT activity had a higher FRS than those with normal ALT activity.

Among men, the adjusted mean difference in the FRS of those with elevated ALT levels compared with men with normal levels was 0.25 (adjusted hazard ratio for CHD, 1.28). Among women, the adjusted mean difference in the FRS was 0.76 (adjusted hazard ratio, 2.14).

"Our results suggest that NAFLD is associated with an increased risk of coronary heart disease," Dr. Ioannou and colleagues say in a press release.

"Most of this excess calculated risk of coronary heart disease in persons with elevated ALT appears to be related to the increased prevalence of insulin resistance, obesity, and central fat distribution which are thought to be the predisposing conditions of NAFLD," they explain.

Hepatology 2006;43:1145-1151.