Sex-influenced association of nonalcoholic fatty liver disease with coronary heart disease

► NAFLD is a predictor of CHD independent of traditional risk factors. ► NAFLD was assessed by CT measured fatty liver and elevated levels of ALT (40 U/L). ► We investigated whether association modification by sex exists between NAFLD and CHD. ► Elevated ALT levels (≥40 U/L) are associated with increased risk of CHD in men only. ► Association of ALT levels (≥40 U/L) with prevalent CHD enhances in non-diabetic men. ► Fatty liver with CHD association may be mediated via insulin resistance and diabetes.