Coronary artery disease in primary biliary cirrhosis: A systematic review and meta‐analysis of observational studies
Abstract
Aim: To investigate the association between primary biliary cirrhosis (PBC) and risk of coronary artery disease (CAD). Methods: We conducted a systematic review and meta‐analysis of published observational studies that reported relative risks, odd ratios, hazard ratios or standardized incidence ratios with 95% confidence intervals (CI) comparing CAD risk in patients with PBC versus non‐PBC controls. Pooled risk ratios and 95% confidence intervals were combined using a random‐effect model and generic inverse variance of DerSimonian and L aird methods. Result: Four studies with 3362 patients with PBC were identified and included in our data analysis. The pooled risk ratio of CAD in patients with PBC was 1.57 (95% CI, 1.21–2.06). The statistical heterogeneity was low with an I 2 of 38%. Conclusion: Our study demonstrated a statistically significant increased risk of CAD among patients with PBC.
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A meta-analysis found a pooled cardiovascular risk of 1.57 (95% CI, 1.21-2.06) in PBC patients with hypercholesterolemia.
“This has been challenged by a meta-analysis that identified a pooled risk of 1.57 (95% CI, 1.21-2.06)(247)”
From Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases (2019) · cites this paper as [247]
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Meta-analysis in clinical trials
DerSimonian, R., & Laird, N. (1986) · Controlled Clinical Trials · doi:10.1016/0197-2456(86)90046-2 · Cited by 39,552 · see citing works
Quantifying heterogeneity in a meta‐analysis
Higgins, J. P. T., & Thompson, S. G. (2002) · Statistics in Medicine · doi:10.1002/sim.1186 · Cited by 36,763 · see citing works
Stang, A. (2010) · European Journal of Epidemiology · doi:10.1007/s10654-010-9491-z · Cited by 17,396 · see citing works
Kaplan, M. M. (1987) · New England Journal of Medicine · doi:10.1056/nejm198702263160907 · Cited by 2,015 · see citing works
Kaplan, M. M., & Gershwin, M. E. (2005) · New England Journal of Medicine · doi:10.1056/nejmra043898 · Cited by 1,144 · see citing works
The interactions between inflammation and coagulation
Esmon, C. T. (2005) · British Journal of Haematology · doi:10.1111/j.1365-2141.2005.05753.x · Cited by 1,004 · see citing works
Cardiovascular death in rheumatoid arthritis: A population‐based study
Kremers, H. M., Nicola, P., Crowson, C. S., Ballman, K. V., & Gabriel, S. E. (2005) · Arthritis & Rheumatism · doi:10.1002/art.20878 · Cited by 934 · see citing works
Niessner, A., Sato, K., Chaikof, E. L., Colmegna, I., Goronzy, J. J., & Weyand, C. M. (2006) · Circulation · doi:10.1161/circulationaha.106.642801 · Cited by 244 · see citing works
Atherosclerosis in Patients With Autoimmune Disorders
Frostegård, J. (2005) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.0000174800.78362.ec · Cited by 235 · see citing works
Montecucco, F., & Mach, F. (2008) · Rheumatology · doi:10.1093/rheumatology/ken395 · Cited by 203 · see citing works
Inflammation, innate immunity and blood coagulation
Xu, J., Lupu, F., & Esmon, C. T. (2010) · Hämostaseologie · doi:10.1055/s-0037-1617146 · Cited by 201 · see citing works
Adaptive (T and B Cells) Immunity and Control by Dendritic Cells in Atherosclerosis
Ait‐Oufella, H., Sage, A. P., Mallat, Z., & Tedgui, A. (2014) · Circulation Research · doi:10.1161/circresaha.114.302761 · Cited by 201 · see citing works
Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis
Longo, M., Crosignani, A., Battezzati, P. M., Squarcia Giussani, C., Invernizzi, P., Zuin, M., & Podda, M. (2002) · Gut · doi:10.1136/gut.51.2.265 · Cited by 190 · see citing works
Incidence and prevalence of primary biliary cirrhosis in the city of Newcastle upon Tyne, England
Metcalf, J. V., Bhopal, R. S., Gray, J. W., Howel, D., & James, O. (1997) · International Journal of Epidemiology · doi:10.1093/ije/26.4.830 · Cited by 176 · see citing works
Primary biliary cirrhosis, hyperlipidemia, and atherosclerotic risk: A systematic review
Sorokin, A., Brown, J. L., & Thompson, P. D. (2007) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2006.11.036 · Cited by 169 · see citing works
Jahn, C. E., Schaefer, E. J., Taam, L., Hoofnagle, J. H., Lindgren, F. T., Albers, J. J., Jones, E. A., & Brewer, H. B. (1985) · PubMed · Cited by 166 · see citing works
Zöller, B., Li, X., Sundquist, J., & Sundquist, K. (2012) · PLoS ONE · doi:10.1371/journal.pone.0033442 · Cited by 154 · see citing works
Lipoprotein abnormalities in primary biliary cirrhosis
Jahn, C. E., Schaefer, E. J., Taam, L., Hoofnagle, J. H., Lindgren, F. T., Albers, J. J., Jones, E. A., & Brewer, H. B. (1985) · Gastroenterology · doi:10.1016/0016-5085(85)90642-0 · Cited by 152 · see citing works
Hypercholesterolemia and Atherosclerosis in Primary Biliary Cirrhosis: What Is the Risk?
Crippin, J. S., Lindor, K. D., Jorgensen, R., Kottke, B. A., Harrison, J. M., Murtaugh, P. A., & Dickson, R. E. (1992) · Hepatology · doi:10.1002/hep.1840150518 · Cited by 149 · see citing works
Hänsel, S., Lässig, G., Pistrosch, F., & Passauer, J. (2003) · Atherosclerosis · doi:10.1016/s0021-9150(03)00281-8 · Cited by 117 · see citing works
Lipoprotein-X reduces LDL atherogenicity in primary biliary cirrhosis by preventing LDL oxidation
Chang, P., Lu, S., Su, T., Chou, S.-F., Huang, W.-H., Morrisett, J. D., Chen, C., Liau, C., & Lee, Y. (2004) · Journal of Lipid Research · doi:10.1194/jlr.m400229-jlr200 · Cited by 114 · see citing works
Natural history of primary biliary cirrhosis
Parés, A., & Rodés, J. (2003) · Clinics in Liver Disease · doi:10.1016/s1089-3261(03)00100-4 · Cited by 89 · see citing works
Ungprasert, P., Suksaranjit, P., Spanuchart, I., Leeaphorn, N., & Permpalung, N. (2014) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2014.03.004 · Cited by 86 · see citing works
Self-citationUngprasert, P., Charoenpong, P., Ratanasrimetha, P., Thongprayoon, C., Cheungpasitporn, W., & Suksaranjit, P. (2014) · Clinical Rheumatology · doi:10.1007/s10067-014-2681-4 · Cited by 75 · see citing works
Self-citationSolaymani-Dodaran, M., Aithal, G. P., Card, T., & West, J. (2008) · The American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2008.02092.x · Cited by 65 · see citing works
van Dam, G. M., & Gips, C. H. (1997) · Scandinavian Journal of Gastroenterology · doi:10.3109/00365529709025067 · Cited by 60 · see citing works
Rho, Y. H., Chung, C. P., Oeser, A. M., Solus, J. F., Gebretsadik, T. S., Shintani, A., Raggi, P., Milne, G. L., & Stein, C. (2010) · Arthritis Care & Research · doi:10.1002/acr.20237 · Cited by 55 · see citing works
Coronary artery disease in giant cell arteritis: A systematic review and meta-analysis
Ungprasert, P., Koster, M. J., & Warrington, K. J. (2014) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2014.10.010 · Cited by 52 · see citing works
Self-citationLecithin—Cholesterol Acyltransferase and the Lipoprotein Abnormalities of Obstructive Jaundice
Agorastos, J., Fox, C., Harry, D. S., & McIntyre, N. (1978) · Clinical Science · doi:10.1042/cs0540369 · Cited by 48 · see citing works
Hyperviscosity Syndrome in a Hypercholesterolemic Patient With Primary Biliary Cirrhosis
Rosenson, R. S., Baker, A. L., Chow, M. J., & Hay, R. V. (1990) · Gastroenterology · doi:10.1016/0016-5085(90)90356-6 · Cited by 45 · see citing works
Gylling, H., Färkkilä, M. A., Vuoristo, M., & Miettinen, T. A. (1995) · Hepatology · doi:10.1002/hep.1840210116 · Cited by 38 · see citing works
Doycheva, I. (2011) · World Journal of Hepatology · doi:10.4254/wjh.v3.i4.93 · Cited by 22 · see citing works
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Lindor, K. D., Bowlus, C. L., Boyer, J., Levy, C., & Mayo, M. (2019) · Hepatology · doi:10.1002/hep.30145 · Cited by 913 · see citing works
S2k Leitlinie Autoimmune Lebererkrankungen
Authors, Collaborators:, durch:, E. B., Deutsche Gesellschaft für Gastroenterologie, V. U. S. (. (., (DGIM), D. G. F. I. M., (DCCV), D. M. C. U. V., e.V., D. L., (DEGUM), D. G. F. U. I. D. M., (DGE-BV), D. G. F. E. U. B. V., (DGKJ), D. G. F. K. U. J., et al. (2017) · Zeitschrift für Gastroenterologie · doi:10.1055/s-0043-120199 · Cited by 85 · see citing works
Ungprasert, P., Srivali, N., Cheungpasitporn, W., & Davis, J. M. (2015) · Joint Bone Spine · doi:10.1016/j.jbspin.2015.05.016 · Cited by 53 · see citing works
Self-citationSimental‐Mendía, L. E., Simental-Mendía, M. A., Sánchez‐García, A., Banach, M., Șerban, M.-C., Cicero, A. F. G., & Sahebkar, A. (2019) · Lipids in Health and Disease · doi:10.1186/s12944-019-1041-4 · Cited by 53 · see citing works
Hyperlipidaemia in primary biliary cholangitis: treatment, safety and efficacy
Wah‐Suárez, M., Danford, C. J., Patwardhan, V. R., Jiang, Z. G., & Bonder, A. (2019) · Frontline Gastroenterology · doi:10.1136/flgastro-2018-101124 · Cited by 42 · see citing works
Diagnosis and treatment of primary biliary cholangitis
Laschtowitz, A., de Veer, R. C., der Meer, A. J. V., & Schramm, C. (2020) · United European Gastroenterology Journal · doi:10.1177/2050640620919585 · Cited by 38 · see citing works
Risk of Cardiovascular Events in Patients with Primary Biliary Cholangitis - Systematic Review
Suraweera, D., Fanous, C., Jimenez, M., Tong, M. J., & Saab, S. (2018) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2017.00064 · Cited by 36 · see citing works
Ungprasert, P., Srivali, N., & Kittanamongkolchai, W. (2015) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2305-5839.2015.02.05 · Cited by 32 · see citing works
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Ungprasert, P., Sanguankeo, A., & Upala, S. (2015) · Modern Rheumatology · doi:10.3109/14397595.2015.1056931 · Cited by 32 · see citing works
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Nevens, F. (2018) · Best Practice & Research Clinical Gastroenterology · doi:10.1016/j.bpg.2018.09.001 · Cited by 27 · see citing works
Comprehensive autoantibody profiles in systemic sclerosis: Clinical cluster analysis
Höppner, J., Tabeling, C., Casteleyn, V., Kedor, C., Windisch, W., Burmester, G. R., Huscher, D., & Siegert, E. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2022.1045523 · Cited by 25 · see citing works
Hepatitis B virus infection and risk of coronary artery disease: a meta-analysis
Wijarnpreecha, K., Thongprayoon, C., Panjawatanan, P., & Ungprasert, P. (2016) · Annals of Translational Medicine · doi:10.21037/atm.2016.11.12 · Cited by 21 · see citing works
Self-citationZhao, D., Yan, H., Han, Y., Zhang, W.-M., Zhao, Y., & Liao, H.-Y. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1142177 · Cited by 16 · see citing works
Liang, Y., Li, J., Zhang, Z., Jiang, T., & Yang, Z. (2024) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2024.102321 · Cited by 14 · see citing works
Ischemic Heart Disease and Liver Cirrhosis: Adding Insult to Injury
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Mawardi, M., Alalwan, A. M., Fallatah, H. I., Abaalkhail, F. A., Hasosah, M. Y., Shagrani, M. A., Alghamdi, M., & Alghamdi, A. (2021) · Saudi Journal of Gastroenterology · doi:10.4103/sjg.sjg_112_21 · Cited by 12 · see citing works
Systemic Complications of Primary Biliary Cholangitis
Zapata, M., Pagán-Torres, H., & Mayo, M. J. (2023) · Clinics in Liver Disease · doi:10.1016/j.cld.2023.07.004 · Cited by 10 · see citing works
The Treatment of Primary Biliary Cholangitis: Time for Personalized Medicine
Men, X., Liu, Y., Zhao, H., Xie, B., Guo, C., Leung, P. S. C., Timilsina, S., Gershwin, M. E., Shang, Y., & Han, Y. (2025) · Clinical Reviews in Allergy & Immunology · doi:10.1007/s12016-025-09074-x · Cited by 8 · see citing works
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Granito, A., Παππάς, Γ., Napoli, L., Stefanini, B., Tirotta, D., & Muratori, P. (2026) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2026.2672493 · Cited by 8 · see citing works
Lin, Y.-L., Yao, T., Wang, Y.-W., Yu, J., Zhen, C., Lin, J., & Chen, S.-B. (2024) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2024.102419 · Cited by 7 · see citing works
Autorinnen/Autoren, & Collaborators (2025) · Zeitschrift für Gastroenterologie · doi:10.1055/a-2558-5204 · Cited by 6 · see citing works
Koop, P., Schwenzer, C., Clusmann, J., Vell, M. S., Jaeger, J. W., Gui, W., Trautwein, C., Koch, A. H., Bruns, T., Schneider, C. V., et al. (2024) · Liver International · doi:10.1111/liv.15945 · Cited by 6 · see citing works
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Muzahim, Y., Wakil, A., Bassi, M., & Pyrsopoulos, N. (2023) · Clinics in Liver Disease · doi:10.1016/j.cld.2023.07.003 · Cited by 3 · see citing works
Li, Y., Zhu, N., & Li, X. (2025) · European journal of medical research · doi:10.1186/s40001-025-03490-7 · Cited by 2 · see citing works
Sebode, M., Bantel, H., Baumann, U., Bufler, P., Demir, M., Dold, L., Keitel, V., Klein, R., Kremer, A. E., Jansen, P. L., et al. (2026) · Zeitschrift für Gastroenterologie · doi:10.1055/a-2769-2475 · Cited by 2 · see citing works
Ruiu, A., Calabrese, M. P., Meschisi, P., Plebani, R., Maria, B., Lleò, A., & Ronca, V. (2026) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2026.106883 · Cited by 1 · see citing works
Tan, J. J.-R., Thiyagarajan, S., Tan, J., Ong, J., Lin, K., Tee, C. H. N., Tan, C. K., Tan, A. G. S., Ang, D., Ang, T. L., et al. (2026) · Canadian Liver Journal · doi:10.3138/canlivj-2026-0019 · Cited by 1 · see citing works
Primary biliary cholangitis presenting as acute ischemic stroke: A rare association
Park, B., Islam, S., Vemulapalli, R. C., & Shreve, M. E. (2020) · Clinical Case Reports · doi:10.1002/ccr3.2590 · Cited by 1 · see citing works
Trivella, J. P., & Levy, C. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-26710-9.00018-3 · Cited by 1 · see citing works
Ungprasert, P., Srivali, N., Cheungpasitporn, W., & Davis, J. M. (2017) · Revue du Rhumatisme · doi:10.1016/j.rhum.2016.12.003
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Phillips, P. K., & Said, A. (2019) · Springer eBooks · doi:10.1007/978-3-030-25626-5_7
Zhao, J. L., Tran, T., Halegoua-DeMarzio, D. L., & Redfield, R. L. (2025) · Archives of Gastroenterology Research · doi:10.33696/gastroenterology.6.073
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Halilbasic, E., Tatscher, E., Aigner, E., Burghart, L., Graziadei, I. W., Hametner‐Schreil, S., Hofer, B., Hofer, H., Maieron, A., Mandorfer, M., et al. (2026) · Wiener klinische Wochenschrift · doi:10.1007/s00508-026-02798-6
Mahmoud, M., Awali, M., Syn, W.-K., & Qureshi, K. (2026) · Exploration of Digestive Diseases · doi:10.37349/edd.2026.1005137
- Authors
- Ungprasert, P., Wijarnpreecha, K., Ahuja, W., Spanuchart, I., & Thongprayoon, C.
- Affiliations
- Mayo Clinic (US)
- Chiang Mai University (TH)
- University of Hawaiʻi at Mānoa (US)
- Corresponding author
- Ungprasert, Patompong
- Venue
- Hepatology Research
- Publisher
- Wiley
- Published
- 2014-12-15
- Volume
- 45
- Issue
- 11
- Pages
- 1055-1061
- ISSN
- 1386-6346 (ISSN-L)
- 1872-034X
- OpenAlex
- W2010161879
- Cited by
- 34
- References
- 33
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 2 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 3
- FWCI
- 0.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Hepatology Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Keywords
- primary biliary cirrhosis, coronary artery disease, cardiovascular risk, disease association, relative risk
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