Liver Enzymes and Cardiovascular Disease Risk

Liver enzymes such as alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT) serve as accessible indicators of hepatic integrity, oxidative stress and metabolic dysfunction. Epidemiological and mechanistic studies have linked elevations in these enzymes to hypertension, atherosclerosis, stroke and cardiovascular mortality. While GGT often shows a linear relationship with incident cardiovascular events, ALT and AST may exhibit U-shaped associations with all-cause and cardiovascular death, reflecting complex interactions between hepatocellular injury, inflammation and systemic risk. Integration of liver enzyme measurement into routine cardiovascular assessments can improve early detection, risk stratification and targeted prevention strategies across diverse populations.

Research from Nature Portfolio

In a nationwide cohort exceeding 16 million adults, rising GGT concentrations were consistently associated with increased risks of myocardial infarction, ischaemic stroke and all-cause mortality over a median of nine years. Unlike ALT and AST, which demonstrated U-shaped mortality curves, GGT exhibited a robust positive linear trend with cardiovascular events and post-event mortality. Participants in the highest GGT quartile experienced significantly greater one-year mortality after myocardial infarction or stroke compared with those in the lowest quartile, independent of traditional risk factors, underscoring GGT’s prognostic value beyond markers of liver damage.

Liver Enzymes and Cardiovascular Disease Risk publication trend

The graph below shows the total number of articles in liver enzymes and cardiovascular disease risk across all publications each year (not limited to Nature Index journals).

Technical terms

Alanine aminotransferase (ALT): An enzyme central to amino acid metabolism, released into the bloodstream following hepatocellular injury.

Aspartate aminotransferase (AST): An enzyme found in liver and cardiac tissues, elevated levels of which indicate cellular damage in these organs.

Gamma-glutamyl transferase (GGT): An enzyme involved in glutathione metabolism and cellular antioxidant defence, linked to cardiometabolic risk.

Metabolic syndrome: A constellation of risk factors—dyslipidaemia, hypertension, insulin resistance and central obesity—that collectively elevate cardiovascular risk.

Mendelian randomisation: A genetic epidemiology approach using inherited variants as proxies to infer causal relationships between biomarkers and disease outcomes.

References

1. Gamma‐Glutamyltransferase: A Predictive Biomarker of Cellular Antioxidant Inadequacy and Disease Risk. Disease Markers (2015).
2. Implication of liver enzymes on incident cardiovascular diseases and mortality: A nationwide population-based cohort study. Scientific Reports (2018).
3. Complex Association between Alanine Aminotransferase Activity and Mortality in General Population: A Systematic Review and Meta-Analysis of Prospective Studies. PLOS ONE (2014).
4. Associations between Life’s Essential 8 and liver function: a cross-sectional study. Frontiers in Nutrition (2025).
5. Potential Causal Association between Elevated Gamma-Glutamyl Transferase Level and Stroke: A Two-Sample Mendelian Randomization Study. Biomolecules (2023).
6. Association between serum liver enzymes and hypertension: a cross-sectional study in Bangladeshi adults. BMC Cardiovascular Disorders (2020).