title: Low ALT Levels Independently Associated with 22-Year All-Cause Mortality Among Coronary Heart Disease Patients.
abstract: BACKGROUND
  Low alanine aminotransferase (ALT) blood levels are known to be associated with frailty and increased risk of long-term mortality in certain populations. However, the contribution of this marker to long-term outcome has not been assessed in patients with chronic coronary heart disease.
  
  
  OBJECTIVE
  The aim of the current study was to assess the association between low ALT values and long-term, 22.8-year, all-cause mortality in this population.
  
  
  METHODS
  We examined the association of low ALT (<17 IU/l) with long-term all-cause mortality in the Bezafibrate Infarction Prevention (BIP) Registry population.
  
  
  RESULTS
  Appropriate laboratory and survival data were available for 6,575 patients, without known liver pathology, included in the BIP registry, with a median follow-up period of 22.8 years. The cumulative probability of all-cause mortality was significantly higher in the low ALT group compared with patients with higher ALT levels (65.6 % vs. 58.4 %; log-rank p < 0.001). Consistently, multivariate analysis, adjusted for multiple established predictors of mortality in this population, demonstrated that low ALT is independently associated with 11 % greater long-term (22.8 years) mortality risk [HR 1.11 (95 % confidence interval: 1.03-1.19; adjusted p < 0.01)].
  
  
  CONCLUSIONS
  Low ALT levels are associated with increased long-term mortality among middle-aged patients with stable coronary heart disease. This association remained statistically significant after adjustment for other well-established risk factors for mortality in this population.
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Peltz-Sinvani
authors.affiliation: Leviev Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Klempfner
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Ramaty
authors.affiliation: Institute of Chemical Pathology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: B A
authors.initials: BA
authors.lastname: Sela
authors.affiliation: Leviev Heart Institute, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Department of Internal Medicine "T", Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. gad.segal@sheba.health.gov.il.|Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel. gad.segal@sheba.health.gov.il.
authors.forename: G
authors.initials: G
authors.lastname: Segal
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D004796:Clinical Enzyme Tests / Q000379:methods; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment / Q000379:methods
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase
keywords: aging; cardiovascular disease; life course; risk assessment; screening; survey research