Related Experiment Videos
Hypercholesterolemia and atherosclerosis in primary biliary cirrhosis: what is the risk?
J S Crippin1, K D Lindor, R Jorgensen
1Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota 55905.
Insights
Primary biliary cirrhosis patients with hypercholesterolemia do not face an increased risk of atherosclerotic death. Further research is needed to understand the mechanisms behind this condition.
Area of Science:
- Hepatology
- Cardiovascular Science
- Lipid Metabolism
Background:
- Hypercholesterolemia frequently accompanies primary biliary cirrhosis (PBC).
- Elevated cholesterol increases atherosclerosis risk in the general population, but this risk is poorly defined in PBC patients.
- The specific hyperlipidemic state in PBC remains understudied.
Purpose of the Study:
- To investigate the risk of atherosclerotic death in patients with primary biliary cirrhosis and hyperlipidemia.
- To characterize the lipid profiles of PBC patients across different disease stages.
Main Methods:
- Prospective observation of 312 PBC patients for a median of 7.4 years.
- Comparison of atherosclerotic death incidence with age- and sex-matched U.S. control population.
- Detailed serum lipid profiling in 50 consecutive PBC patients.
Main Results:
- No statistically significant difference in atherosclerotic death incidence was found between PBC patients and controls.
- Total cholesterol and LDL cholesterol increased with disease severity.
- HDL cholesterol was elevated across all stages, peaking in stages 2 and 3. Triglycerides were normal or slightly elevated; apolipoprotein A-I was elevated except in stage 4.
Conclusions:
- The hyperlipidemia associated with primary biliary cirrhosis does not appear to elevate the risk of atherosclerotic death.
- Further studies with larger sample sizes are warranted.
- Investigating the pathophysiological mechanisms of hypercholesterolemia in PBC is recommended.
Abstract:
Hypercholesterolemia is commonly associated with primary biliary cirrhosis. In the general population, elevated serum cholesterol is associated with an increased risk of atherosclerosis. The relative risk has been poorly defined in primary biliary cirrhosis patients with hyperlipidemia. In addition, the hyperlipidemic state seen with primary biliary cirrhosis has not been well studied. We prospectively observed 312 patients with primary biliary cirrhosis for a median of 7.4 yr. During this period, 128 patients died. The incidence of atherosclerotic death in patients with primary biliary cirrhosis was not statistically different when compared with an age-matched and sex-matched U.S. control population. A similar group of 50 consecutive PBC patients had detailed serum lipid profiles. Findings included progressive increases in total cholesterol and low-density lipoprotein cholesterol with an increasing histological stage or severity of disease. High-density lipoprotein cholesterol was elevated in all stages, with the highest levels in histological stage 2 and 3 disease. Triglycerides were normal or slightly elevated in all stages. Apoprotein A-I was elevated in all but histological stage 4 disease. Our study suggests the hyperlipidemia associated with primary biliary cirrhosis does not place these patients at risk for atherosclerotic death. In light of the limitations imposed by our relatively small sample size, however, additional patients should be studied. Furthermore, an examination of the pathophysiological mechanisms leading to hypercholesterolemia should be the topic of further study.