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Updated: Jan 21, 2026
Fusion of Secretory Vesicles with the Plasma Membrane
Hypercholesterolaemia is not associated with early atherosclerotic lesions in primary biliary cirrhosis
M Allocca1, A Crosignani, A Gritti
1Dipartimento di Medicina, Chirurgia e Odontoiatria, Polo Universitario Ospedale San Paolo, Via Di Rudinì 8, 20143 Milan, Italy.
Insights
Hypercholesterolaemia in primary biliary cirrhosis (PBC) does not consistently link to subclinical atherosclerosis. However, treatment is advised if other cardiovascular disease risk factors are present in PBC patients.
Area of Science:
- Cardiovascular Medicine
- Hepatology
- Clinical Research
Background:
- Hypercholesterolaemia is common in primary biliary cirrhosis (PBC) due to chronic cholestasis.
- The association between hypercholesterolaemia and cardiovascular risk in PBC patients remains unclear.
Purpose of the Study:
- To investigate the relationship between hypercholesterolaemia and subclinical atherosclerosis in patients with primary biliary cirrhosis.
Main Methods:
- Ultrasound imaging of carotid arteries was used to assess intima-media thickness (IMT) and stenosis.
- Study included 103 PBC patients and matched hypercholesterolaemic and normocholesterolaemic controls.
Main Results:
- Hypercholesterolaemic PBC patients showed lower IMT and stenosis prevalence than hypercholesterolaemic controls.
- Hypercholesterolaemia was not consistently linked to increased IMT or carotid stenosis in PBC patients, unlike in controls.
Conclusions:
- Hypercholesterolaemia is not a consistent marker for subclinical atherosclerosis in primary biliary cirrhosis.
- Treatment for hypercholesterolaemia in PBC is recommended when other cardiovascular disease risk factors are present.
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 > or =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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