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 longterm 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. PARTICIPANTS: We examined the association of low ALT (<17 IU/l) with long-term all-cause mortality in the Bezafibrate Infarction Prevention (BIP) Registry population. KEY 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.

Low alanine aminotransferase levels predict low muscle strength in older patients with diabetes: A nationwide cross‐sectional study in Korea

“…Previous longitudinal studies suggested that low ALT <13–19 IU/L levels increase frailty, disability and mortality . The present study also showed that similar cut‐off values of ALT <18.5 IU/L can predict the risk of low muscle strength in older patients with diabetes.…”

“…22 Low ALT level is also a negative factor that increases cardiovascular and all-cause mortality. 9,23 Based on these data, it seems that there is a "missing link" between low DBP and low ALT.…”

“…Alanine aminotransferase (ALT) is an emerging biomarker of frailty in older adults . In several cohort studies, low‐to‐normal ALT has been shown to increase frailty, all‐cause mortality and cardiovascular mortality . However, in patients with diabetes, ALT levels are often elevated as a result of accompanying metabolic factors, such as obesity and dyslipidemia, and clinicians tend to focus only on high ALT.…”

“…6 In several cohort studies, low-to-normal ALT has been shown to increase frailty, all-cause mortality and cardiovascular mortality. [7][8][9][10][11] However, in patients with diabetes, ALT levels are often elevated as a result of accompanying metabolic factors, such as obesity and dyslipidemia, and clinicians tend to focus only on high ALT. However, we wondered whether it is safe to assume patients with diabetes with low normal ALT levels are metabolically healthy.…”

Capsule Commentary on Peltz-Sinvani et al., Low ALT Levels Independently Associated with 22-Year All-Cause Mortality among Coronary Heart Disease Patients

“…In this study, Peltz-Sinvani et al 1 assessed the association between low ALT (<17 IU/L) blood levels and long-term (22.8 years) all-cause mortality in patients with stable coronary heart disease. The authors used the Bezafibrate Infarction Prevention (BIP) registry population, which contains over 15,000 patients 40 to 74 years of age with stable coronary heart disease who have been followed continuously for over two decades.…”