Elevated Liver Transaminase Levels: A Biomarker for Severe Coronary Atherosclerosis?

Figure: Liver transaminase levels and coronary atherosclerosis.Purpose: Elevated liver transaminase levels in serum have been associated with components of metabolic syndrome and non-alcoholic fatty liver disease (NAFLD), both of which are positively correlated with coronary artery disease (CAD). The objective of this study is to evaluate the relationship between liver transaminase levels (ALT, AST) and angiographically documented coronary atherosclerosis in a cohort of elderly (>65 years) patients. Methods: This was an IRB-approved retrospective study. Of the 1,808 elderly patients who underwent elective cardiac catheterization from 2008 to 2012, 1,222 had ALT/AST levels checked prior to cardiac catheterization, lacked a history of significant alcohol consumption (as per AGA definition), and lacked a history of ST-elevation myocardial infarction (STEMI), were included. Patients were subdivided into two cohorts, based on normal (n=925) and elevated transaminase levels (n=297), (ALT>50 U/L, AST>40 U/L). Baseline characteristics and coronary angiographic findings were recorded. Significant CAD was defined as >50% stenosis. CAD was subdivided into 1-, 2-, and 3-vessel CAD. Cohorts were compared with chi-square and unpaired t-tests, using STATA IC 12.1 statistical software. Results: Both cohorts were similar in terms of traditional cardiovascular risk factors: sex, BMI, diabetes, hypertension, hyperlipidemia and smoking, except age (1.5 years higher in the elevated AST/ALT cohort, compared to normal cohort). Elevated transaminase levels were associated with: a) Greater prevalence of 3-vessel CAD (29.0% vs. 22.3% in normal cohort, p=0.019) b) Higher mean number of vessels involved (1.59 vs 1.33 in normal cohort, p=0.004). Cohorts were similar in terms of 1-vessel, 2-vessel, and left main disease. Conclusion: NAFLD manifested as elevated ALT/AST levels may predict presence of severe coronary artery disease. Further prospective studies are needed to test the feasibility of using serum ALT/AST levels as biomarkers for coronary atherosclerosis.