Elevated hepatic enzymes and incidence of venous thromboembolism: A prospective study

Aaron R. Folsom, Pamela L. Lutsey, Nicholas S. Roetker, Wayne D. Rosamond, Mariana Lazo, Susan R. Heckbert, Saonli Basu, Mary Cushman, Elizabeth Selvin

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Purpose: Approximately 10% of the general population has elevated blood concentrations of hepatic enzymes, which are linked to increased coagulation markers. We tested whether elevated hepatic enzymes are associated with increased risk of venous thromboembolism (VTE). Methods: We followed 12,604 adults with measurements of alanine transaminase, aspartate aminotransferase (AST), and gamma-glutamyl transpeptidase (GGT) prospectively for VTE occurrence. Results: AST and GGT above the laboratory normal values were associated over two decades of follow-up with increased risk of total (n=532) and provoked VTE (n=332), but with not unprovoked VTE (n=200). In a model adjusted for age, race, sex, hormone replacement, alcohol intake, diabetes, body mass index, estimated glomerular filtration rate, and C-reactive protein, the hazard ratios (HR) (95% confidence interval) for high versus normal AST were 1.46 (1.00-2.11) for total VTE and 1.83 (1.21-2.79) for provoked VTE. For high GGT, the HR were 1.34 (1.06-1.69) for total VTE and 1.43 (1.07-1.91) for provoked VTE. When follow-up was limited to the first 10 years, associations were even stronger (HR≈1.7 for total VTE). Conclusions: Elevated concentrations of two hepatic enzymes (AST and GGT) in this general middle-aged population are associated with a modestly increased risk of VTE.

Original languageEnglish (US)
Pages (from-to)817-821.e2
JournalAnnals of epidemiology
Issue number11
StatePublished - Nov 1 2014

Bibliographical note

Funding Information:
Sources of funding: This study was funded by National Institute of Diabetes and Digestive and Kidney Diseases grant R01 DK089174 , National Heart, Lung, and Blood Institute grant R01 HL059367 , and Atherosclerosis Risk in Communities (ARIC) Study contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C. Roche Diagnostics provided material support (reagents) for the hepatic enzyme assays.

Publisher Copyright:
© 2014 Elsevier Inc.


  • Cohort study
  • Liver enzymes
  • Pulmonary embolus
  • Risk factors
  • Venous thrombosis


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