Liver enzymes: Potential cardiovascular risk markers?

Current Pharmaceutical Design

Volumn 17, Issue 33, 2011, Pages 3632-3643

  Lioudaki, Eirini ^a,b   Ganotakis, Emmanuel S ^b   Mikhailidis, Dimitri P ^a  

^a ROYAL FREE AND UNIVERSITY COLLEGE MEDICAL SCHOOL   (United Kingdom)

^b UNIVERSITY OF CRETE   (Greece)

Author keywords

Alanine aminotransferase; Aspartate aminotransferase; Cardiovascular disease; Cardiovascular risk; Diabetes mellitus; Gamma glutamyltransferase; Liver enzyme; Metabolic syndrome; Non alcoholic fatty liver disease

Indexed keywords

ALANINE AMINOTRANSFERASE; AMINOTRANSFERASE; ASPARTATE AMINOTRANSFERASE; BLOOD CLOTTING FACTOR 13B; GAMMA GLUTAMYLTRANSFERASE; GLUCOSE; HIGH DENSITY LIPOPROTEIN CHOLESTEROL; LIVER ENZYME; TRIACYLGLYCEROL;

ALANINE AMINOTRANSFERASE BLOOD LEVEL; ALCOHOL CONSUMPTION; ARTICLE; ATHEROSCLEROSIS; ATHEROSCLEROTIC PLAQUE; CARDIOVASCULAR DISEASE; CARDIOVASCULAR RISK; CAUSE OF DEATH; DIABETES MELLITUS; DISEASE ASSOCIATION; DYSLIPIDEMIA; ENZYME ACTIVITY; EVENT FREE SURVIVAL; FATTY LIVER; FOLLOW UP; GLUCOSE BLOOD LEVEL; HUMAN; HYPERTENSION; HYPERTRIGLYCERIDEMIA; INCIDENCE; INSULIN RESISTANCE; INSULIN SENSITIVITY; ISCHEMIC HEART DISEASE; META ANALYSIS (TOPIC); METABOLIC SYNDROME X; MORTALITY; NONALCOHOLIC FATTY LIVER; OBESITY; OXIDATIVE STRESS; PREDICTION; PREDICTIVE VALUE; PREVALENCE; PRIORITY JOURNAL; STROKE; TRIACYLGLYCEROL BLOOD LEVEL;

ALANINE TRANSAMINASE; ASPARTATE AMINOTRANSFERASES; BIOLOGICAL MARKERS; CARDIOVASCULAR DISEASES; DIABETES MELLITUS; FATTY LIVER; GAMMA-GLUTAMYLTRANSFERASE; HUMANS; LIVER; METABOLIC SYNDROME X; RISK FACTORS; TREATMENT OUTCOME;

EID: 82055186816     PISSN: 13816128     EISSN: 18734286     Source Type: Journal    
DOI: 10.2174/138161211798220945     Document Type: Article

References (108)

1. Kew MC. Serum aminotransferase concentration as evidence of hepatocellular damage. Lancet 2000; 355: 591-2.
2. Baou K, Vlachopoulos C, Manesis E, et al. Non-alcoholic fatty liver and cardiovascular disease: an emerging relationship. Hellenic J Cardiol 2007; 48: 37-41.
3. Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol 2003; 98: 960-7.
4. Westerbacka J, Corner A, Tiikkainen M, et al. Women and men have similar amounts of liver and intra-abdominal fat, despite more subcutaneous fat in women: implications for sex differences in markers of cardiovascular risk. Diabetologia 2004; 47: 1360-9.
5. Schindhelm RK, Diamant M, Dekker JM, et al. Alanine aminotransferase as a marker of non-alcoholic fatty liver disease in relation to type 2 diabetes mellitus and cardiovascular disease. Diabetes Metab Res Rev 2006; 22: 437-43.
6. Kotronen A, Juurinen L, Hakkarainen A, et al. Liver fat is increased in type 2 diabetic patients and underestimated by serum alanine aminotransferase compared with equally obese nondiabetic subjects. Diabetes Care 2008; 31: 165-9.
7. Cortez-Pinto H, Camilo ME, Baptista A, et al. Non-alcoholic fatty liver: another feature of the metabolic syndrome? Clin Nutr 1999; 18: 353-8.
8. Marchesini G, Brizi M, Bianchi G, et al. Nonalcoholic fatty liver disease: a feature of the metabolic syndrome. Diabetes 2001; 50: 1844-50.
9. Targher G, Bertolini L, Rodella S, et al. Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care 2007; 30: 2119-21.
10. Ioannou GN. Implications of elevated serum alanine aminotransferase levels: think outside the liver. Gastroenterology 2008; 135: 1851-4.
11. Liangpunsakul S, Chalasani N. Unexplained elevations in alanine aminotransferase in individuals with the metabolic syndrome: results from the third National Health and Nutrition Survey (NHANES III). Am J Med Sci 2005; 329: 111-6.
12. Ruhl CE, Everhart JE. Determinants of the association of overweight with elevated serum alanine aminotransferase activity in the United States. Gastroenterology 2003; 124: 71-9.
13. Oda E, Kawai R, Watanabe K, Sukumaran V. Prevalence of metabolic syndrome increases with the increase in blood levels of gamma glutamyltransferase and alanine aminotransferase in Japanese men and women. Intern Med 2009; 48: 1343-50.
14. Saely CH, Vonbank A, Rein P, et al. Alanine aminotransferase and gamma-glutamyl transferase are associated with the metabolic syndrome but not with angiographically determined coronary atherosclerosis. Clin Chim Acta 2008; 397: 82-6.
15. Patel DA, Srinivasan SR, Xu JH, et al. Persistent elevation of liver function enzymes within the reference range is associated with increased cardiovascular risk in young adults: the Bogalusa Heart Study. Metabolism 2007; 56: 792-8.
16. Kang YH, Min HG, Kim IJ, et al. Comparison of alanine aminotransferase, white blood cell count, and uric acid in their association with metabolic syndrome: a study of Korean adults. Endocr J 2008; 55: 1093-102.
17. Kim HC, Choi KS, Jang YH, et al. Normal serum aminotransferase levels and the metabolic syndrome: Korean National Health and Nutrition Examination Surveys. Yonsei Med J 2006; 47: 542-50.
18. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002; 106: 3143-421.
19. Suh SY, Choi SE, Ahn HY, et al. The association between normal alanine aminotransferase levels and the metabolic syndrome: 2005 Korean National Health and Nutrition Examination Survey. Metabolism 2009; 58: 1731-6.
20. Yun KE, Shin CY, Yoon YS, Park HS. Elevated alanine aminotransferase levels predict mortality from cardiovascular disease and diabetes in Koreans. Atherosclerosis 2009; 205: 533-7.
21. Kain K, Carter AM, Grant PJ, Scott EM. Alanine aminotransferase is associated with atherothrombotic risk factors in a British South Asian population. J Thromb Haemost 2008; 6: 737-41.
22. Salazar MR, Carbajal HA, Curciarello JO, et al. Alanineaminotransferase: an early marker for insulin resistance? Medicina (B Aires) 2007; 67: 125-30.
23. Selden MA, Helzberg JH, Waeckerle JF, et al. Elevated alanine aminotransferase in current national football league players: correlation with cardiometabolic syndrome markers, obesity, and insulin resistance. South Med J 2009; 102: 1003-6.
24. Olynyk JK, Knuiman MW, Divitini ML, et al. Serum alanine aminotransferase, metabolic syndrome, and cardiovascular disease in an Australian population. Am J Gastroenterol 2009; 104: 1715-22.
25. Kawamoto R, Kohara K, Tabara Y, et al. Serum gamma-glutamyl transferase levels are associated with metabolic syndrome in community- dwelling individuals. J Atheroscler Thromb 2009; 16: 355-62.
26. Rejeb J, Omezzine A, Boumaiza I, et al. Elevated Liver Enzymes in Metabolic Syndrome Are Associated With Coronary Stenosis in a Tunisian Population. Metab Syndr Relat Disord 2010.
27. Rantala AO, Lilja M, Kauma H, et al. Gamma-glutamyl transpeptidase and the metabolic syndrome. J Intern Med 2000; 248: 230-8.
28. Hanley AJ, Williams K, Festa A, et al. Liver markers and development of the metabolic syndrome: the insulin resistance atherosclerosis study. Diabetes 2005; 54: 3140-7.
29. Schindhelm RK, Dekker JM, Nijpels G, et al. Alanine aminotransferase and the 6-year risk of the metabolic syndrome in Caucasian men and women: the Hoorn Study. Diabet Med 2007; 24: 430-5.
30. Goessling W, Massaro JM, Vasan RS, et al. Aminotransferase levels and 20-year risk of metabolic syndrome, diabetes, and cardiovascular disease. Gastroenterology 2008; 135: 1935-44, 1944 e1.
31. Jo SK, Lee WY, Rhee EJ, et al. Serum gamma-glutamyl transferase activity predicts future development of metabolic syndrome defined by 2 different criteria. Clin Chim Acta 2009; 403: 234-40.
32. Kang YH, Min HK, Son SM, et al. The association of serum gamma glutamyltransferase with components of the metabolic syndrome in the Korean adults. Diabetes Res Clin Pract 2007; 77: 306-13.
33. Sakuta H, Suzuki T, Yasuda H, Ito T. Gamma-glutamyl transferase and metabolic risk factors for cardiovascular disease. Intern Med 2005; 44: 538-41.
34. Kim DJ, Noh JH, Cho NH, et al. Serum gamma-glutamyltransferase within its normal concentration range is related to the presence of diabetes and cardiovascular risk factors. Diabet Med 2005; 22: 1134-40.
35. Nakanishi N, Suzuki K, Tatara K. Serum gamma-glutamyltransferase and risk of metabolic syndrome and type 2 diabetes in middle-aged Japanese men. Diabetes Care 2004; 27: 1427-32.
36. Ohlson LO, Larsson B, Bjorntorp P, et al. Risk factors for type 2 (non-insulin-dependent) diabetes mellitus. Thirteen and one-half years of follow-up of the participants in a study of Swedish men born in 1913. Diabetologia 1988; 31: 798-805.
37. Vozarova B, Stefan N, Lindsay RS, et al. High alanine aminotransferase is associated with decreased hepatic insulin sensitivity and predicts the development of type 2 diabetes. Diabetes 2002; 51: 1889-95.
38. Knowler WC, Pettitt DJ, Saad MF, Bennett PH. Diabetes mellitus in the Pima Indians: incidence, risk factors and pathogenesis. Diabetes Metab Rev 1990; 6: 1-27.
39. Schindhelm RK, Diamant M, Bakker SJ, et al. Liver alanine aminotransferase, insulin resistance and endothelial dysfunction in normotriglyceridaemic subjects with type 2 diabetes mellitus. Eur J Clin Invest 2005; 35: 369-74.
40. Sattar N, Scherbakova O, Ford I, et al. Elevated alanine aminotransferase predicts new-onset type 2 diabetes independently of classical risk factors, metabolic syndrome, and C-reactive protein in the west of Scotland coronary prevention study. Diabetes 2004; 53: 2855-60.
41. Hanley AJ, Williams K, Festa A, et al. Elevations in markers of liver injury and risk of type 2 diabetes: the insulin resistance atherosclerosis study. Diabetes 2004; 53: 2623-32.
42. Doi Y, Kubo M, Yonemoto K, et al. Liver enzymes as a predictor for incident diabetes in a Japanese population: the Hisayama study. Obesity (Silver Spring) 2007; 15: 1841-50.
43. Nannipieri M, Gonzales C, Baldi S, et al. Liver enzymes, the metabolic syndrome, and incident diabetes: the Mexico City diabetes study. Diabetes Care 2005; 28: 1757-62.
44. Monami M, Bardini G, Lamanna C, et al. Liver enzymes and risk of diabetes and cardiovascular disease: results of the Firenze Bagno a Ripoli (FIBAR) study. Metabolism 2008; 57: 387-92.
45. Fraser A, Harris R, Sattar N, et al. Alanine aminotransferase, gamma-glutamyltransferase, and incident diabetes: the British Women's Heart and Health Study and meta-analysis. Diabetes Care 2009; 32: 741-50.
46. Wannamethee SG, Shaper AG, Lennon L, Whincup PH. Hepatic enzymes, the metabolic syndrome, and the risk of type 2 diabetes in older men. Diabetes Care 2005; 28: 2913-8.
47. Kim CH, Park JY, Lee KU, et al. Association of serum gammaglutamyltransferase and alanine aminotransferase activities with risk of type 2 diabetes mellitus independent of fatty liver. Diabetes Metab Res Rev 2009; 25: 64-9.
48. Lee DH, Jacobs DR, Jr., Gross M, et al. Gammaglutamyltransferase is a predictor of incident diabetes and hypertension: the Coronary Artery Risk Development in Young Adults (CARDIA) Study. Clin Chem 2003; 49: 1358-66.
49. Meisinger C, Lowel H, Heier M, et al. Serum gammaglutamyltransferase and risk of type 2 diabetes mellitus in men and women from the general population. J Intern Med 2005; 258: 527-35.
50. Sabanayagam C, Shankar A, Li J, et al. Serum gamma-glutamyl transferase level and diabetes mellitus among US adults. Eur J Epidemiol 2009; 24: 369-73.
51. Lim JS, Lee DH, Park JY, et al. A strong interaction between serum gamma-glutamyltransferase and obesity on the risk of prevalent type 2 diabetes: results from the Third National Health and Nutrition Examination Survey. Clin Chem 2007; 53: 1092-8.
52. Monami M, Balzi D, Lamanna C, et al. Prognostic value of serum liver enzymes levels in type 2 diabetic patients. Diabetes Metab Res Rev 2007; 23: 625-30.
53. Ruhl CE, Everhart JE. Elevated serum alanine aminotransferase and gamma-glutamyltransferase and mortality in the United States population. Gastroenterology 2009; 136: 477-85 e11.
54. Fraser A, Thinggaard M, Christensen K, Lawlor DA. Alanine aminotransferase, gamma-glutamyltransferase (GGT) and all-cause mortality: results from a population-based Danish twins study alanine aminotransferase, GGT and mortality in elderly twins. Liver Int 2009; 29: 1494-9.
55. Ruttmann E, Brant LJ, Concin H, et al. Gamma-glutamyltransferase as a risk factor for cardiovascular disease mortality: an epidemiological investigation in a cohort of 163,944 Austrian adults. Circulation 2005; 112: 2130-7.
56. Strasak AM, Kelleher CC, Klenk J, et al. Longitudinal change in serum gamma-glutamyltransferase and cardiovascular disease mortality: a prospective population-based study in 76,113 Austrian adults. Arterioscler Thromb Vasc Biol 2008; 28: 1857-65.
57. Kazemi-Shirazi L, Endler G, Winkler S, et al. Gamma glutamyltransferase and long-term survival: is it just the liver? Clin Chem 2007; 53: 940-6.
58. Wannamethee G, Ebrahim S, Shaper AG. Gammaglutamyltransferase: determinants and association with mortality from ischemic heart disease and all causes. Am J Epidemiol 1995; 142: 699-708.
59. Wannamethee SG, Lennon L, Shaper AG. The value of gammaglutamyltransferase in cardiovascular risk prediction in men without diagnosed cardiovascular disease or diabetes. Atherosclerosis 2008; 201: 168-75.
60. Lee DH, Buijsse B, Steffen L, et al. Association between serum gamma-glutamyltransferase and cardiovascular mortality varies by age: the Minnesota Heart Survey. Eur J Cardiovasc Prev Rehabil 2009; 16: 16-20.
61. Hozawa A, Okamura T, Kadowaki T, et al. gamma- Glutamyltransferase predicts cardiovascular death among Japanese women. Atherosclerosis 2007; 194: 498-504.
62. Fraser A, Harris R, Sattar N, et al. Gamma-glutamyltransferase is associated with incident vascular events independently of alcohol intake: analysis of the British Women's Heart and Health Study and Meta-Analysis. Arterioscler Thromb Vasc Biol 2007; 27: 2729-35.
63. Ebrahim S, Sung J, Song YM, et al. Serum cholesterol, haemorrhagic stroke, ischaemic stroke, and myocardial infarction: Korean national health system prospective cohort study. BMJ 2006; 333: 22.
64. Jousilahti P, Rastenyte D, Tuomilehto J. Serum gamma-glutamyl transferase, self-reported alcohol drinking, and the risk of stroke. Stroke 2000; 31: 1851-5.
65. Bots ML, Salonen JT, Elwood PC, et al. Gamma-glutamyltransferase and risk of stroke: the EUROSTROKE project. J Epidemiol Community Health 2002; 56 Suppl 1: i25-9.
66. Schindhelm RK, Dekker JM, Nijpels G, et al. Alanine aminotransferase predicts coronary heart disease events: a 10-year follow-up of the Hoorn Study. Atherosclerosis 2007; 191: 391-6.
67. Lee DH, Silventoinen K, Hu G, et al. Serum gammaglutamyltransferase predicts non-fatal myocardial infarction and fatal coronary heart disease among 28,838 middle-aged men and women. Eur Heart J 2006; 27: 2170-6.
68. Meisinger C, Doring A, Schneider A, Lowel H. Serum gammaglutamyltransferase is a predictor of incident coronary events in apparently healthy men from the general population. Atherosclerosis 2006; 189: 297-302.
69. Stojakovic T, Scharnagl H, Trauner M, et al. Serum gammaglutamyl transferase and mortality in persons undergoing coronary angiography-The Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 2010; 208: 564-71.
70. Emdin M, Passino C, Michelassi C, et al. Additive prognostic value of gamma-glutamyltransferase in coronary artery disease. Int J Cardiol 2009; 136: 80-5.
71. Emdin M, Passino C, Michelassi C, et al. Prognostic value of serum gamma-glutamyl transferase activity after myocardial infarction. Eur Heart J 2001; 22: 1802-7.
72. Karlson BW, Wiklund O, Hallgren P, et al. Ten-year mortality amongst patients with a very small or unconfirmed acute myocardial infarction in relation to clinical history, metabolic screening and signs of myocardial ischaemia. J Intern Med 2000; 247: 449-56.
73. Adibi P, Sadeghi M, Mahsa M, et al. Prediction of coronary atherosclerotic disease with liver transaminase level. Liver Int 2007; 27: 895-900.
74. Blayney MJ, Pisoni RL, Bragg-Gresham JL, et al. High alkaline phosphatase levels in hemodialysis patients are associated with higher risk of hospitalization and death. Kidney Int 2008; 74: 655-63.
75. Regidor DL, Kovesdy CP, Mehrotra R, et al. Serum alkaline phosphatase predicts mortality among maintenance hemodialysis patients. J Am Soc Nephrol 2008; 19: 2193-203.
76. Tonelli M, Curhan G, Pfeffer M, et al. Relation between alkaline phosphatase, serum phosphate, and all-cause or cardiovascular mortality. Circulation 2009; 120: 1784-92.
77. Kim SK, Kim DJ, Kim SH, et al. Normal range of alanine aminotransferase concentration is associated with carotid atherosclerosis. Diabetes Res Clin Pract 2010; 88: 111-6.
78. Wang CC, Lin SK, Tseng YF, et al. Elevation of serum aminotransferase activity increases risk of carotid atherosclerosis in patients with non-alcoholic fatty liver disease. J Gastroenterol Hepatol 2009; 24: 1411-6.
79. Song SH, Kwak IS, Kim YJ, et al. Can gamma-glutamyltransferase be an additional marker of arterial stiffness? Circ J 2007; 71: 1715-20.
80. Verrijken A, Francque S, Mertens I, et al. Visceral adipose tissue and inflammation correlate with elevated liver tests in a cohort of overweight and obese patients. Int J Obes (Lond) 2010.
81. Fain JN. Release of interleukins and other inflammatory cytokines by human adipose tissue is enhanced in obesity and primarily due to the nonfat cells. Vitam Horm 2006; 74: 443-77.
82. Rocha VZ, Libby P. Obesity, inflammation, and atherosclerosis. Nat Rev Cardiol 2009; 6: 399-409.
83. Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. Eur Heart J 2008; 29: 2959-71.
84. Tordjman J, Guerre-Millo M, Clement K. Adipose tissue inflammation and liver pathology in human obesity. Diabetes Metab 2008; 34: 658-63.
85. Kerner A, Avizohar O, Sella R, et al. Association between elevated liver enzymes and C-reactive protein: possible hepatic contribution to systemic inflammation in the metabolic syndrome. Arterioscler Thromb Vasc Biol 2005; 25: 193-7.
86. Yamada J, Tomiyama H, Yambe M, et al. Elevated serum levels of alanine aminotransferase and gamma glutamyltransferase are markers of inflammation and oxidative stress independent of the metabolic syndrome. Atherosclerosis 2006; 189: 198-205.
87. Lee DH, Jacobs DR, Jr. Association between serum gammaglutamyltransferase and C-reactive protein. Atherosclerosis 2005; 178: 327-30.
88. [Hijona E, Hijona L, Arenas JI, Bujanda L. Inflammatory mediators of hepatic steatosis. Mediators Inflamm 2010: 837419.
89. Libby P, Ridker PM, Hansson GK. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009; 54: 2129-38.
90. Vogiatzi G, Tousoulis D, Stefanadis C. The role of oxidative stress in atherosclerosis. Hellenic J Cardiol 2009; 50: 402-9.
91. Chapman MJ, Sposito AC. Hypertension and dyslipidaemia in obesity and insulin resistance: pathophysiology, impact on atherosclerotic disease and pharmacotherapy. Pharmacol Ther 2008; 117: 354-73.
92. Lee DS, Evans JC, Robins SJ, et al. Gamma glutamyl transferase and metabolic syndrome, cardiovascular disease, and mortality risk: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2007; 27: 127-33.
93. Karp DR, Shimooku K, Lipsky PE. Expression of gamma-glutamyl transpeptidase protects ramos B cells from oxidation-induced cell death. J Biol Chem 2001; 276: 3798-804.
94. Paolicchi A, Minotti G, Tonarelli P, et al. Gamma-glutamyl transpeptidase-dependent iron reduction and LDL oxidation--a potential mechanism in atherosclerosis. J Investig Med 1999; 47: 151-60.
95. [Turgut O, Tandogan I. Gamma-glutamyltransferase to Determine Cardiovascular Risk: Shifting the Paradigm Forward. J Atheroscler Thromb.
96. Gurdol F, Nwose OM, Mikhailidis DP. Gamma-glutamyl Transferase Activity in Human Platelets: Quantification of Activity, Isoenzyme Characterization and Potential Clinical Relevance. Platelets 1995; 6: 200-3.
97. Bolodeoku JA, Ganotakis ES, Mikhailidis DP, Winder AF. Correlation between serum gamma-glutamyl transferase activity and the platelet count. Platelets 1997; 8: 333-5.
98. Leppala JM, Paunio M, Virtamo J, et al. Alcohol consumption and stroke incidence in male smokers. Circulation 1999; 100: 1209-14.
99. Gronbaek M, Johansen D, Becker U, et al. Changes in alcohol intake and mortality: a longitudinal population-based study. Epidemiology 2004; 15: 222-8.
100. Anton RF, Stout RL, Roberts JS, Allen JP. The effect of drinking intensity and frequency on serum carbohydrate-deficient transferrin and gamma-glutamyl transferase levels in outpatient alcoholics. Alcohol Clin Exp Res 1998; 22: 1456-62.
101. Breimer LH, Mikhailidis DP. Could carbon monoxide and bilirubin be friends as well as foes of the body? Scand J Clin Lab Invest. 2010; 70: 1-5.
102. Diakou MC, Liberopoulos EN, Mikhailidis DP, Tsianos EV, Burroughs AK, Elisaf MS. Pharmacological treatment of non-alcoholic steatohepatitis: the current evidence. Scand J Gastroenterol. 2007; 42: 139-47
103. Athyros VG, Mikhailidis DP, Didangelos TP, Giouleme OI, Liberopoulos EN, Karagiannis A, Kakafika AI, Tziomalos K, Burroughs AK, Elisaf MS. Effect of multifactorial treatment on nonalcoholic fatty liver disease in metabolic syndrome: a randomised study. Curr Med Res Opin. 2006; 22: 873-83.
104. Filippatos TD, Kiortsis DN, Liberopoulos EN, Georgoula M, Mikhailidis DP, Elisaf MS. Effect of orlistat, micronised fenofibrate and their combination on metabolic parameters in overweight and obese patients with the metabolic syndrome: the FenOrli study. Curr Med Res Opin. 2005; 21: 1997-2006.
105. Athyros VG, Tziomalos K, Karagiannis A, Mikhailidis DP. Cardiovascular benefits of bariatric surgery in morbidly obese patients. Obes Rev. 2011; 12: 515-24.
106. [Katsiki N, Athyros VG, Karagiannis A, Mikhailidis DP. Hyperuricaemia and Non-Alcoholic Fatty Liver Disease (NAFLD): A Relationship with Implications for Vascular Risk? Curr Vasc Pharmacol. 2011 Mar 10. [Epub ahead of print]
107. Athyros VG, Tziomalos K, Daskalopoulos GN, Karagiannis A, Mikhailidis DP. Statin-based treatment for cardiovascular risk and non-alcoholic fatty liver disease. Killing two birds with one stone? Ann Med. 2011; 43: 167-71.
108. Athyros VG, Tziomalos K, Gossios TD, Griva T, Anagnostis P, Kargiotis K, Pagourelias ED, Theocharidou E, Karagiannis A, Mikhailidis DP; GREACE Study Collaborative Group. Safety and efficacy of long-term statin treatment for cardiovascular events in patients with coronary heart disease and abnormal liver tests in the Greek Atorvastatin and Coronary Heart Disease Evaluation (GREACE) Study: a post-hoc analysis. Lancet. 2010; 376: 1916-22.