What are the implications of elevated Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels, as well as hypercholesterolemia?

From the Guidelines

Elevated AST, ALT, and cholesterol levels indicate potential liver dysfunction and cardiovascular risk that require immediate medical attention, and adopting a low-fat, plant-based diet, regular exercise, and possibly medication like statins can help improve these conditions. According to the most recent study 1, hepatocellular injury causes the release of ALT and AST in serum, and an increase in ALT is directly linked to hepatocyte injury. The study also highlights that non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in first-world countries, with a prevalence of 20% to 30% in the general population, and this increases to 70% with obesity and 90% with diabetes mellitus.

Some key points to consider:

• Elevated AST and ALT levels can be caused by various factors, including fatty liver disease, viral hepatitis, and medications/toxins, as stated in the study 1.
• Hypercholesterolemia can increase the risk of cardiovascular events, and managing cholesterol levels is crucial, as mentioned in the study 1.
• Lifestyle modifications, such as adopting a low-fat, plant-based diet and regular exercise, can help improve liver function and cholesterol levels.
• Medications like statins, such as atorvastatin (10-80mg daily) or rosuvastatin (5-40mg daily), may be recommended to manage high cholesterol, and liver enzymes should be monitored regularly, as suggested in the study 1.
• Weight loss of even 5-10% can significantly improve liver enzyme and cholesterol levels if the individual is overweight.

It is essential to consult with a healthcare provider for proper evaluation and guidance on managing these conditions, as they can provide personalized recommendations and monitor progress. The liver plays a central role in cholesterol metabolism, and conditions like non-alcoholic fatty liver disease can cause both elevated liver enzymes and cholesterol disturbances, as highlighted in the study 1.

From the FDA Drug Label

Liver Enzyme Abnormalities and Monitoring: Increases in serum transaminases have been reported with use of ezetimibe tablets. Perform liver enzyme testing as clinically indicated and consider withdrawal of ezetimibe tablets if increases in ALT or AST ≥3 X ULN persist.

The implications of elevated Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels are that they may be associated with liver enzyme abnormalities. If increases in ALT or AST ≥3 X ULN persist, consideration should be given to withdrawing ezetimibe tablets. Regarding hypercholesterolemia, ezetimibe tablets are indicated to reduce elevated LDL-C in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH) 2.

From the Research

Implications of Elevated AST and ALT Levels

• Elevated Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) levels are associated with liver damage and are often seen in patients with non-alcoholic fatty liver disease (NAFLD) 3, 4.
• Studies have shown that statin treatment can improve liver tests and reduce cardiovascular morbidity in patients with mild-to-moderately abnormal liver tests potentially attributable to NAFLD 3.
• The use of statins was not associated with elevated liver enzymes in patients with NAFLD, and significantly lower levels of ALT were observed in statin users compared to non-statin users 4.

Implications of Hypercholesterolemia

• Hypercholesterolemia is a key risk factor for cardiovascular disease, and statins are the first-line treatment to reduce atherogenic lipids 5, 6, 7.
• Fixed-dose combinations of ezetimibe and atorvastatin have been shown to be effective in reducing low-density lipoprotein cholesterol (LDL-C) levels and are well tolerated 5, 6.
• The combination of different hypolipidemic regimens in a fixed-dose formulation can enhance adherence to hypolipidemic treatment, leading to improved outcomes 7.

Treatment Options

• Statin monotherapy may not be sufficient to achieve LDL-C targets in high-risk patients, and combination therapy with other hypolipidemic drugs may be necessary 5, 6, 7.
• Fixed-dose combinations of hypolipidemic agents, such as ezetimibe and atorvastatin, may provide an attractive option for the effective and safe management of hypercholesterolemia 5, 6, 7.
• Novel hypolipidemic drugs, such as bembedoic acid and berberine, have shown promising initial results and may be considered as additional treatment options 7.