Hypercholesterolaemia is not associated with early atherosclerotic lesions in primary biliary cirrhosis
Open accessAbstract
Background: Hypercholesterolaemia often occurs in primary biliary cirrhosis (PBC) as a result of chronic cholestasis, but whether these patients are exposed to greater cardiovascular risk is unknown. Aim: To establish whether hypercholesterolaemia is associated with subclinical atherosclerosis in PBC. Patients: 103 consecutive patients with PBC (37 with total cholesterol ⩾6.21 mmol/l) and 37 controls with hypercholesterolaemia, and 141 matched controls with normocholesterolaemia. Methods: Ultrasound imaging of carotid artery to determine intima–media thickness (IMT) and stenosis. Results: Controls with hypercholesterolaemia had higher IMT and prevalence of carotid stenosis compared with patients with hypercholesterolaemic PBC (mean (SD) 0.850 (0.292) mm v 0.616 (0.137) mm, p c<0.001; 43% v 19%, p c = 0.129) who, in turn, were similar to the 66 patients with normocholesterolaemic PBC (0.600 (0.136) mm; 5%). Compared with subjects with normocholesterolaemia, controls with hypercholesterolaemia, but not patients with hypercholesterolaemic PBC, had an increased risk of raised IMT (odds ratio (OR) 5.4, 95% confidence interval (CI) 2.5 to 11.9, p<0.001; and 0.7, 0.3 to 2.0, p = 0.543) or carotid stenosis (8.2, 3.4 to 20, p<0.001; and 2.5, 0.9 to 6.9, p = 0.075). In PBC, compared with younger patients without hypertension, the risk of increased IMT was OR (CI) 3.1 (0.6 to 17; p = 0.192) in patients with hypertension or old age, but not hypercholesterolaemia, and 4.6 (0.8 to 27; p = 0.096) in patients who also had hypercholesterolaemia. The corresponding figures for risk of stenosis were 3.6 (0.4 to 36; p = 0.277) and 15.8 (1.8 to 141; p = 0.014). Conclusions: Hypercholesterolaemia is not consistently associated with subclinical atherosclerosis in PBC, but should be treated if other risk factors for cardiovascular disease are also present. The search for factors that may protect patients with hypercholesterolaemic PBC against atherosclerosis should be encouraged.
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PBC patients are not at increased risk of death from atherosclerosis, unlike patients with increased serum lipids without PBC.
“It is clinically significant that HDL cholesterol is elevated whilst LDL cholesterol is not, and patients with PBC are not at increased risk of death from atherosclerosis, which is the case for patients with increased serum lipid levels without PBC [49,50].”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [50]
The introduction reports that earlier studies suggested fatal cardiovascular events in PBC may not be increased, but cautions that mortality findings can be biased by deaths from liver disease. This paper compares early carotid atherosclerotic lesions in PBC patients and non-PBC controls with high cholesterol; it does not establish the claimed difference in death from atherosclerosis. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPatients with PBC have not been robustly reported to have an associated increased cardiac risk.
“However, patients with PBC have not been robustly reported to have an associated increased cardiac risk [49,50].”
From EASL Clinical Practice Guidelines: The diagnosis and management of patients with primary biliary cholangitis. (2017) · cites this paper as [50]
Retrospective studies indicate no elevated cardiovascular disease risk in PBC patients with hypercholesterolemia.
“retrospective studies suggest that there is no increased risk of cardiovascular disease in patients with PBC and hypercholesterolemia. (84,(244)(245)(246)”
From Primary Biliary Cholangitis: 2018 Practice Guidance from the American Association for the Study of Liver Diseases (2019) · cites this paper as [245]
Patients with PBC typically present with hyperlipidemia, showing elevated levels of TC, HDL-C and LDL-C, which is not associated with increased atherosclerotic diseases in this population.
“Patients with PBC typically present with hyperlipidemia, showing elevated levels of TC, HDL‐C and LDL‐C,31 which is not associated with increased atherosclerotic diseases in this population.32”
From NGM282 for Treatment of Patients With Primary Biliary Cholangitis: A Multicenter, Randomized, Double‐Blind, Placebo‐Controlled Trial (2018) · cites this paper as [32]
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References 36 · Cited by 92
- Authors
- Allocca, M., Crosignani, A., Gritti, A., Ghilardi, G., Gobatti, D., Caruso, D., Zuin, M., Podda, M., & Battezzati, P. M.
- Affiliations
- Ospedale San Paolo (IT)
- University of Milan (IT)
- Corresponding author
- Battezzati, P M
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2006-04-21
- Volume
- 55
- Issue
- 12
- Pages
- 1795-1800
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- PMC
- PMC1856484
- OpenAlex
- W2135782763
- Semantic Scholar
- 514366b92c90103b0ae44a0c66b5bbd6bbd1c3b6
- Cited by
- 92
- References
- 36
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 3 · 2021: 4 · 2020: 1 · 2019: 7 · 2018: 8 · 2017: 4 · 2015: 5 · 2014: 2 · 2013: 5 · 2012: 6
- FWCI
- 4.95
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gut (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- primary biliary cirrhosis, hypercholesterolemia, subclinical atherosclerosis, intima-media thickness, carotid artery stenosis, cardiovascular risk, chronic cholestasis, hypertension, age, dyslipidemia, cardiovascular disease prevention, dyslipidemia management, lifestyle modification, statins
- MeSH terms
- Age Factors, Carotid Arteries, Cholesterol, Female, Humans, Hypercholesterolemia, Hypertension, Liver Cirrhosis, Biliary, Male, Middle Aged, Risk Factors, Ultrasonography, Carotid Stenosis, Tunica Intima, Atherosclerosis
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