Cardiovascular risk profiles in patients with primary sclerosing cholangitis

Chronic inflammation as seen in patients with primary sclerosing cholangitis (PSC) is linked to accelerated development and progression of atherosclerosis. This study aimed to assess atherosclerotic cardiovascular disease (ASCVD) risk and cardiovascular health (CVH) profiles in patients with PSC.

This cross-sectional study included PSC patients with and without concomitant inflammatory bowel disease (IBD), assessing cardiovascular risk with anthropometric measurements, serum samples, self-reported questionnaires, and medical chart review. The ideal CVH score was calculated according to the American Heart Association guidelines. Comparisons across groups were analyzed using χ 2 and Mann-Whitney U-test.

Ninety-eight patients with PSC were included [72% male; median age 49 years, interquartile range: 34-61 years], with 65% having concomitant IBD. PSC-IBD patients exhibited higher prevalence of obesity (15% vs 0%; P = 0.016), hypertension (35% vs 21%; P = 0.069), diabetes (9% vs 3%; P = 0.525), active smokers (10% vs 3%; P = 0.253) and metabolic syndrome (8% vs 3%; P = 0.363), and lower prevalence of hypercholesterolemia (30% vs 50%; P = 0.020). Nonideal CVH was more common among PSC-IBD (46% vs 22%; P  = 0.045). Ten patients had a history of 16 ASCVD events. At time of these events, at 13/16 events patients had one or more traditional ASCVD risk factors of which 77% were modifiable.

One-third of PSC patients exhibit nonideal CVH, particularly PSC-IBD patients. In this cohort, 10% had prior ASCVD with mostly modifiable risk factors at time of the event. These findings suggest that PSC patients might benefit from proactive ASCVD surveillance and risk management.