Key result
Elevated GGT linked to ~4.1-fold higher odds of intermediate-to-high 10-year cardiovascular risk.
Why the study?
Previous studies on liver enzymes and CVD risk yielded conflicting results, and evidence linking liver enzymes to the 10-year Framingham Risk Score was limited.
Are elevated serum liver enzyme levels (ALT, AST, ALP, and GGT) associated with an intermediate to high 10-year Framingham Risk Score (≥10%) in Iranian adults aged 35 to 70 years without baseline cardiovascular disease?
Cross-Sectional (n=14,219)
No
Are elevated serum liver enzyme levels (ALT, AST, ALP, and GGT) associated with an intermediate to high 10-year Framingham Risk Score (≥10%) in Iranian adults aged 35 to 70 years without baseline cardiovascular disease?
In a large cross-sectional Iranian cohort, elevated serum levels of ALT, AST, ALP, and especially GGT were independently associated with a 10-year Framingham Risk Score ≥10%, suggesting routine liver enzyme assessment may help identify patients with elevated estimated cardiovascular risk.
Answers are grounded in this paper and cite their sources.
Liver enzymes should not yet inform CVD risk stratification; leaves open whether GGT adds incremental value in prospective cohorts.
Earlier studies examining the relationship between liver enzymes and cardiovascular disease (CVD) risk have produced conflicting results, and there is limited evidence demonstrating that liver enzymes influence the Framingham Risk Score (FRS). This cross-sectional study investigates whether liver enzymes are assocaited with the 10-year FRS in a large population sample from the AZAR cohort. This study utilized a large sample of 14,219 individuals aged 35 to 70 years from the AZAR cohort. Demographic characteristics, physical activity levels, liver enzyme levels, and anthropometric variables were assessed. The 10-year Framingham Risk Score (FRS) was calculated according to the Adult Treatment Panel III (ATP III) guidelines. Participants were categorized into two groups for analysis :those with a low (<10%) and those with intermediate to high risk (>=10%). Binary logistic regression was employed to examine the relationship between liver enzymes and the 10-year risk of cardiovascular disease (CVD), adjusting for confounding factors. After adjusting for confounding factors, the second and third tertiles of four liver enzymes were associated with higher odds of an FRS ≥ 10%, compared with the first tertile. Among the liver enzymes examined, GGT showed the strongest association with an FRS ≥ 10%, with adjusted odds ratios (AORs) of 2.67 (95% CI: 2.36–3.03; p < 0.001) for the second tertile and 4.10 (95% CI: 3.63–4.64; p < 0.001) for the third tertile, compared to the first tertile. Although AST was also significantly associated with an FRS ≥ 10%, the strength of this association was weaker than that observed for the other liver enzymes. For AST, the association was more pronounced in the third tertile than in the second tertile. In this cross-sectional study, all four liver enzymes were significantly associated with the 10-year Framingham Risk Score (FRS), with GGT showing the strongest association. Based on these findings, assessing liver enzyme levels alongside other clinical factors may help identify individuals with an elevated estimated risk of cardiovascular disease (CVD).
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Safari et al. (2026) conducted a cross-sectional in Estimated 10-year cardiovascular disease risk (n=14,219). Elevated serum liver enzymes (highest tertile GGT >= 26 U/L; also ALT, AST, ALP) vs. Lowest tertile of serum liver enzymes (GGT <= 16 U/L) was evaluated on 10-year Framingham Risk Score (FRS) >= 10% (intermediate to high estimated cardiovascular disease risk) (OR 4.10, 95% CI 3.63-4.64, p=<0.001). Higher levels of liver enzymes (ALT, AST, ALP, GGT) were associated with a 10-year Framingham Risk Score >= 10%, with highest-tertile GGT showing the strongest association.
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