Can liver biomarkers help predict my 10-year risk of ASCVD events in the US or China?
Liver function biomarkers, such as gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP), and globulin, are increasingly recognized as useful additions to standard risk prediction models for atherosclerotic cardiovascular disease (ASCVD). Research shows that these markers can help refine 10-year risk estimates in both US and Chinese populations, beyond what traditional risk factors alone provide. This means that your doctor might consider liver biomarker levels when assessing your personal ASCVD risk.
What the research says
A 2024 study analyzed data from the US National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS) to see if liver biomarkers improve hard ASCVD risk prediction 3. Among 5,731 US participants, GGT showed an independent linear association with 10-year ASCVD risk, partly mediated by systolic blood pressure (44.8%), HbA1c (19.0%), and HDL cholesterol (13.4%) 3. Machine learning models that added GGT, ALP, and globulin to traditional risk factors improved predictive accuracy, with the Naive Bayes model achieving an AUC of 0.751 in NHANES validation 3. External validation in the Chinese CHARLS cohort confirmed these findings, suggesting the approach works across populations 3.
Another 2025 study in a Chinese community of 6,110 adults found that liver steatosis (fatty liver) and fibrosis (scarring) were associated with higher 10-year ASCVD risk, as calculated by the China-PAR model 10. The association was partly mediated by inflammatory markers like high-sensitivity C-reactive protein (hs-CRP) and metabolic factors such as insulin resistance (HOMA-IR) and remnant cholesterol 10. This suggests that liver health influences cardiovascular risk through inflammation and metabolic pathways.
A 2025 study in type 2 diabetes patients with MASLD (metabolic dysfunction-associated steatotic liver disease) also found that hepatic fibrosis, measured by the SAFE score, was significantly associated with 10-year ASCVD risk, especially in those with hypertension, insulin resistance, or elevated LDL cholesterol 11. Each unit increase in SAFE score corresponded to a 0.07-unit increase in 10-year ASCVD risk score 11.
Additionally, a 2025 UK Biobank study identified a proteomic signature of MASLD that was strongly linked to ASCVD risk, and integrating these proteins into the SCORE2 model improved prediction for ischemic heart disease, peripheral artery disease, and stroke in MASLD patients 9. This reinforces the idea that liver-related biomarkers, whether traditional enzymes or advanced protein profiles, can enhance ASCVD risk assessment.
What to ask your doctor
- Should I have my liver enzymes (GGT, ALP) checked as part of my ASCVD risk assessment?
- Do my liver biomarker levels suggest I need more aggressive cardiovascular prevention?
- How do my liver function test results fit with my current 10-year ASCVD risk score?
- If I have fatty liver disease, what additional steps can I take to lower my heart disease risk?
- Are there any specific lifestyle changes or medications that could improve both my liver health and heart risk?
This question is drawn from common patient questions about this topic and answered using cited medical research. We do not provide individualized advice.