However, using the enzymes in a simple ratio (AST/ALT) or as a component of panel marker tests has been shown to have diagnostic accuracy for significant liver disease.15, 16 In addition, these surrogates of liver injury improve the prediction of future clinical events including cardiovascular outcomes in patients with liver disease.17, 18 However, it is still unknown whether the AST/ALT ratio can improve prediction for cardiovascular outcomes in a general primary care population. This evidence concerns the gene GPT and liver disorder.