Question re ALT and Triglycerides

My husband is almost 34.  He has had high triglycerides in the past, and that has been about his only health problem.  5 years ago they were high and he got them down through diet.  2 years ago they were high and he was told to go on Niacin, which he did for a while, then stopped.  He takes no medicines, sometimes takes vitamins, eats pretty well.  He doesn't drink daily, sometimes 1, sometimes 4, probably averages out to less than 2 per day.  He drinks beer.  

He just had his annual visit.  Everything was fine except:
Vitamin D-23 (doctor sent a prescription for vitamin D)
Triglycerides-around 250 (doctor sent a prescription for niacin)
Cholesterol-209; good chol. was low, although bad chol. was not high; ratio was high, 6.5 I think
GFR was slightly high but doctor wrote "okay" next to it.
AST: just slightly high.  In the 50's, I think.
ALT: 119.

The doctor noted the last two numbers to be high, but didn't give any guidance or instruction (this was in a letter).  He has asked him to come in 2 months from now for fasting bloodwork.

I am worried about his ALT.  Do you think some other follow-up is warranted other than retesting in 2 months?  I don't think it's ever been high before.  I am worried about hepatitis issues in particular because I have RA and just started Humira.  I assume that is something that he would have had for a while though, I have no reason to think he would have acquired it recently.  

His father has problems with high triglycerides too, so I'm wondering if ALT is connected to that.  His mother is in good health so far as I know.  His siblings as well, although his brother has hypothyroidism.  

All of his other bloodwork was normal, including TSH, blood counts, etc.  

Thank you for your response!  I had to about force him to the doctor and now he thinks I am overreacting about the ALT, but I feel the doctor should explain something to him before 2 months from now, but he did not.  

Katie

[J.M. Keyes, MD]

Hi,
A reasonable first step is a repeat fasting bloodwork for your husband.  The cholesterol will be more accurate if fasting, and it will show if the liver enzymes have changed or returned to normal.  I certainly understand your concern regarding the elevated liver enzymes, and he should cut out all alcohol until he has his bloodwork repeated, as alcohol intake may be playing a role in this.  He should cut back on the alcohol anyway, as this will also increase his tryglycerides, among other things.
Your doctor will also probably also consider testing for causes of hepeatitis with the repeat bloodwork (or if the ALT remains elevated).  If there is still an abnormality, I would also consider an abdominal ultrasound to rule out other causes.  
The most common reason for elevated liver enzymes in the US is fatty liver, which can be caused by obesity, dyslipidemia (abnormal lipids), alcohol intake.  An ultrasound would show if there is fatty infiltration of the liver.

It is very important that your husband take these issues seriously, because over time this can cause serious liver damage.  As well, high triglycerides (TGs) can contribute to heart disease which is the number one killer in our society.  He can likely significantly lower his TGs with diet and cutting out the alcohol, so if he really doesn't want to take the niacin because of side effects, maybe he can be aggressive with lifestyle changes until the repeat bloodwork, and then discuss the options with his physician.

So, as a recap- most important right now is to make some lifestyle changes with respect to diet and alcohol intake (and weight reduction if this is an issue).  Get the repeat bloodwork fasting and ask the physician about testing for different causes of hepatitis and an ultrasound.  Trial lifestyle changes and/or niacin for increased TGs- there are other more potent medications if this is not working.

I hope this helps.  
Good luck,
JMK MD