High alanine aminotransferase level as a predictor for the incidence of macrovascular disease in type 2 diabetic patients with fatty liver disease

We investigated whether fatty liver (FL) disease in type 2 diabetic mellitus (T2DM) patients affects their incidence of macrovascular disease. In addition, we detected a useful marker for predicting the incidence of macrovascular disease events. A total of 458 patients who underwent abdominal ultrasonography (US) between April 2003 and March 2004 in a diabetic clinic were divided into FL (n = 211) and non-FL (NFL; n = 247) groups, and followed by a diabetologist and/or hepatologist for 5 years. No significant difference in the incidence of macrovascular disease, neither cerebrovascular disease nor coronary heart disease, was observed between FL and NFL patients. Interestingly, in FL diabetic patients, only an alanine aminotransferase (ALT) level ≥30 IU/l was significantly associated with the incidence of macrovascular events in univariate (odds ratio [OR], 10.632; 95 % confidence interval [CI], 1.302–86.841; p = 0.0274) and multivariate (OR, 10.134; CI 1.223–83.995; p = 0.0318) analyses. Patients with higher ALT levels had a higher cumulative incidence of macrovascular disease events than did those with lower ALT levels (p = 0.0068). In conclusion, an ALT level ≥30 IU/l is an independent risk indicator of macrovascular disease in diabetic patients with FLD, whereas the presence of FL itself in T2DM patients is not associated with an increased incidence of macrovascular events. Our findings indicate that therapeutic interventions may be necessary for FL patients with high ALT levels to prevent macrovascular disease.