title: The association of liver enzymes with biomarkers of subclinical myocardial damage and structural heart disease.
abstract: OBJECTIVE
  Patients with non-alcoholic fatty liver disease (NAFLD) are thought to be at increased risk of cardiovascular morbidity and mortality. However, the relationships between NAFLD and subclinical myocardial injury or structural heart disease are unknown.
  
  
  METHODS
  We conducted a cross-sectional analysis of 8668 participants from the Atherosclerosis Risk in Communities (ARIC) Study, who showed no clinical evidence of cardiovascular disease. We used levels of liver enzymes (alanine aminotransferase [ALT], aspartate aminotransferase [AST] and gamma-glutamyl transpeptidase [GGT]), in the context of no history of elevated alcohol consumption as non-invasive surrogates of NAFLD. We used highly sensitive cardiac troponin T (hs-cTnT) and N-terminal pro-Brain natriuretic peptide (NT-proBNP) as biomarkers of myocardial damage and function.
  
  
  RESULTS
  In this population-based study (mean age 63 years, 60% women, 78% white), higher levels of ALT, AST, and GGT, even within the normal range, were significantly and independently associated with detectable (hs-cTnT >3 ng/L) and elevated (hs-cTnT ⩾14 ng/L) concentrations of hs-cTnT. The adjusted odds ratios (95% confidence interval) for elevated liver enzymes (vs. normal levels) with elevated hs-cTnT were: 1.65 (1.28-2.14) for ALT, 1.90 (1.36-2.68) for AST, and 1.55 (1.13-2.12) for GGT. Furthermore, there was evidence for inverse associations of ALT and AST with NT-proBNP.
  
  
  CONCLUSIONS
  Our results suggest that elevated liver enzyme levels in the absence of elevated alcohol consumption may be associated with subclinical myocardial injury. The inverse association between NT-proBNP and both ALT and AST supports the recently described metabolic role of natriuretic peptides.
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: mlazo@jhu.edu.
authors.forename: Mariana
authors.initials: M
authors.lastname: Lazo
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rubin
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Jeanne M
authors.initials: JM
authors.lastname: Clark
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Josef
authors.initials: J
authors.lastname: Coresh
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Andrea L C
authors.initials: AL
authors.lastname: Schneider
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Chiadi
authors.initials: C
authors.lastname: Ndumele
authors.affiliation: Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.affiliation: Department of Medicine, Section of Atherosclerosis and Vascular Medicine, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.affiliation: Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology and the Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
mesh_terms: D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D058070:Asymptomatic Diseases; D015415:Biomarkers / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D065626:Non-alcoholic Fatty Liver Disease / Q000453:epidemiology*; D010446:Peptide Fragments / Q000097:blood*; D012307:Risk Factors; D013223:Statistics as Topic; D020107:Troponin T / Q000097:blood*; D014481:United States / Q000453:epidemiology; D005723:gamma-Glutamyltransferase / Q000097:blood*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D020107:Troponin T; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: NAFLD; Natriuretic peptides; Subclinical cardiac damage; Troponin T