Established major chronic diseases such as major cardiovascular disease (history of myocardial infarction, stroke, heart failure, coronary artery bypass graft, arrhythmia, peripheral arterial disease), bleeding disorder or anticoagulation use, active cancer, end-stage renal disease, proteinuria (>3g/day), dementia, severe chronic obstructive pulmonary disease (needs systemic steroid therapy), significant liver disease (ALT-AST>300). Here, GPT is linked to chronic kidney disease.