title: Elevated hepatic enzymes and incidence of venous thromboembolism: a prospective study.
abstract: OBJECTIVE
  Approximately 10% of the general population has elevated blood concentrations of hepatic enzymes, which are linked to increased coagulation markers. We tested whether elevated hepatic enzymes are associated with increased risk of venous thromboembolism (VTE).
  
  
  METHODS
  We followed 12,604 adults with measurements of alanine transaminase, aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) prospectively for VTE occurrence.
  
  
  RESULTS
  AST and GGT above the laboratory normal values were associated over two decades of follow-up with increased risk of total (n = 532) and provoked VTE (n = 332), but with not unprovoked VTE (n = 200). In a model adjusted for age, race, sex, hormone replacement, alcohol intake, diabetes, body mass index, estimated glomerular filtration rate, and C-reactive protein, the hazard ratios (HR) (95% confidence interval) for high versus normal AST were 1.46 (1.00-2.11) for total VTE and 1.83 (1.21-2.79) for provoked VTE. For high GGT, the HR were 1.34 (1.06-1.69) for total VTE and 1.43 (1.07-1.91) for provoked VTE. When follow-up was limited to the first 10 years, associations were even stronger (HR ≈ 1.7 for total VTE).
  
  
  CONCLUSIONS
  Elevated concentrations of two hepatic enzymes (AST and GGT) in this general middle-aged population are associated with a modestly increased risk of VTE.
authors.affiliation: Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis. Electronic address: folso001@umn.edu.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.affiliation: Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Lutsey
authors.affiliation: Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Roetker
authors.affiliation: Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: Department of Epidemiology, University of Washington, Seattle.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis.
authors.forename: Saonli
authors.initials: S
authors.lastname: Basu
authors.affiliation: Department of Medicine, University of Vermont, Burlington; Department of Pathology, University of Vermont, Burlington.
authors.forename: Mary
authors.initials: M
authors.lastname: Cushman
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood*; D000428:Alcohol Drinking; D001219:Aspartate Aminotransferases / Q000097:blood*; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood* / Q000453:epidemiology / Q000208:ethnology; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: Cohort study; Liver enzymes; Pulmonary embolus; Risk factors; Venous thrombosis