What is the significance of elevated Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT), and Alkaline Phosphatase (ALP) along with hyperlipidemia, specifically elevated Low-Density Lipoprotein (LDL) of 205?

From the Guidelines

Elevated AST, ALT, alkaline phosphatase, and LDL of 205 mg/dL suggest both liver dysfunction and high cholesterol requiring medical attention, and the most recent guidelines recommend statin therapy for patients with NAFLD and high LDL cholesterol, as seen in the 2021 study by the Clinical and Molecular Hepatology 1. You should schedule an appointment with your healthcare provider for a complete evaluation. For the elevated liver enzymes, avoid alcohol, acetaminophen, and potentially hepatotoxic medications while awaiting further testing, which may include a complete liver panel, ultrasound, or other imaging. Some key points to consider in the evaluation of elevated liver enzymes include:

• Hepatocellular injury causes the release of ALT and AST in serum, and an increase in ALT is directly linked to hepatocyte injury 1
• The severity of abnormal aminotransferase can be classified as mild, moderate, or severe, and the severity can guide the need for further testing and treatment 1
• Pathologically increased levels of ALP may occur in cholestatic liver disease, which can show elevated ALP with or without elevated bilirubin 1 For the high LDL cholesterol, dietary changes are recommended including reducing saturated fats, increasing fiber intake, and consuming more plant sterols found in vegetables, nuts, and whole grains. Regular exercise of at least 150 minutes per week of moderate activity is also beneficial. Some key points to consider in the management of high LDL cholesterol include:
• The NCEP guidelines for drug therapy for LDL cholesterol elevations should apply, and statins such as atorvastatin or rosuvastatin may be prescribed if lifestyle changes are insufficient 1
• The use of statins in children and adolescents with high LDL cholesterol is more controversial, but may be recommended in certain cases, such as familial hypercholesterolemia or multifactorial dyslipidemia 1 The liver enzyme elevations could be related to fatty liver disease, which is associated with high cholesterol, or could indicate other liver conditions such as viral hepatitis, medication effects, or autoimmune disorders. Both issues require proper medical evaluation to determine the underlying cause and appropriate treatment plan. Some key points to consider in the evaluation and management of fatty liver disease include:
• NAFLD is a spectrum of fat deposition and hepatic inflammation followed by fibrosis due to metabolic insults, and can be associated with high cholesterol and other metabolic disorders 1
• Statin therapy can be beneficial in patients with NAFLD and high LDL cholesterol, as it can reduce liver enzyme elevations and improve cardiovascular outcomes 1

From the Research

Elevated AST, ALT, and ALK Phos with High LDL

• Elevated levels of AST, ALT, and ALK Phos, along with a high LDL of 205, may indicate liver damage or dysfunction, potentially related to high cholesterol levels 2, 3, 4, 5.
• Studies have shown that combination therapy with ezetimibe and a statin can effectively lower LDL cholesterol levels and improve liver function in patients with hypercholesterolemia and non-alcoholic fatty liver disease (NAFLD) 2, 4, 6.
• The combination of ezetimibe and atorvastatin has been shown to reduce LDL cholesterol levels by 37% compared to baseline, with 84% of patients reaching their LDL cholesterol goals 3.
• Ezetimibe has also been found to decrease insulin resistance associated with NAFLD, and combination therapy with rosuvastatin has been shown to significantly reduce liver fat in patients with NAFLD 2, 6.

Treatment Options

• Combination therapy with ezetimibe and a statin, such as atorvastatin or rosuvastatin, may be a effective treatment option for patients with elevated AST, ALT, and ALK Phos, and high LDL levels 2, 3, 4, 5, 6.
• Ezetimibe has been shown to be well-tolerated and effective in reducing LDL cholesterol levels and improving liver function in patients with hypercholesterolemia and NAFLD 2, 3, 4, 5, 6.
• Further research is needed to fully understand the effects of combination therapy on liver function and cardiovascular risk in patients with elevated liver enzymes and high LDL levels 2, 6.