Association between elevated serum alanine aminotransferase and cardiometabolic risk factors in rural Chinese population: a cross-sectional study

Elevated alanine aminotransferase (ALT) levels may be associated with metabolic syndrome and cardiovascular diseases. This study aimed to investigate the association between elevated ALT levels and cardiometabolic risk factors in a rural Chinese population.

This was a cross-sectional study conducted from July 2012 to August 2013, including 11,573 subjects (5,357 men and 6,216 women) aged ≥35 years in rural areas of Liaoning Province. A physical examination was performed and metabolic indicators were examined under standard protocols. Subjects were divided into those with elevated ALT levels (>40U/L) and those with normal ALT levels (≤40U/L).

Participants with elevated ALT levels had higher levels of almost all cardiometabolic risk factors than those with normal ALT levels. In individuals with elevated ALT levels, weight, height, waist circumference, and body mass index (BMI), which are indicators for general and abdominal obesity, were significantly higher (p < 0.001) than those in individuals with normal ALT levels. There was no significant difference in race, current smoking, or physical activity between the two groups. Other cardiometabolic risk factors, such as systolic blood pressure, diastolic blood pressure, and fasting plasma glucose, TC, TG, low-density lipoprotein cholesterol, and serum uric acid levels, were higher in participants with elevated ALT levels than in those with normal ALT levels. Logistic regression analysis showed that male sex, younger age, and the presence of high TC, high TG, and low high-density lipoprotein cholesterol levels, current smoking status, BMI ≥25 kg/m², abdominal obesity, hyperuricemia, and HtgW phenotype were significantly (p < 0.05) associated with elevated ALT levels. Sex-related differences were also investigated. For men, hypertension (OR 1.33, 95 % CI 1.08–1.62), high TC levels (OR 1.63, 95 % CI 1.23–2.17), high TG levels (OR 1.62, 95 % CI 1.25–2.09), BMI ≥25 kg/m² (OR 1.52, 95 % CI 1.07–2.18), and hyperuricemia (OR 1.92, 95 % CI 1.52–2.40) were significantly (p < 0.05) related to elevated serum ALT levels, but this was not observed in women.

There are significant relationships of elevated ALT levels with cardiometabolic risk factors and several sex-related differences in rural Chinese. Elevated serum ALT levels are associated with a worse cardiac risk profile.