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The diagnosis cardiovascular of primary NASH requires the exclusion of drugs which have been reported to produce secondary NASH, such as amiodarone, perhexilene maleate, synthetic estrogens, glucocorticoids and tamoxifen. The most common finding at initial presentation is hepatomegaly,7-9 but splenomegaly, ascites and spider cardiovascular nevi are rare. Laboratory Features: The most frequently noted abnormality is a two-to threefold elevation of cardiovascular serum levels of ALT and AST.3,7-10 In the individual patient, the AST/ALT ratio will not discriminate alcoholic from non-alcoholic disease. Even if an AST/ALT ratio of greater than three is found significantly more often (p>0.001) in patients with alcoholic liver disease (82%), the ratio also exceeds three in 32% of nonalcoholics in one study.8 In another study,7 ratios of more than one are seen in 40% of nonalcoholics.
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