Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis

M. Longo, A. Crosignani, P. M. Battezzati, C. Squarcia Giussani, P. Invernizzi, M. Zuin, Mauro Podda

Research output: Contribution to journalArticle

126 Citations (Scopus)

Abstract

Background: Primary biliary cirrhosis (PBC), a chronic cholestatic liver disease, is frequently associated with severe hypercholesterolaemia but the clinical significance of this finding is unclear. Aims: To characterise changes in serum lipid profile over time and to assess the risk of cardiovascular disease in PBC. Subjects and methods: We studied a cohort of 400 PBC patients for 6.2 years (range 4 months to 24 years) by serial determinations of serum lipid levels and registration of all cardiovascular events. Subjects included in an Italian prospective population based study served as controls. Results: At presentation, 76% of patients had serum cholesterol levels >5.2 mmol/l. Hyperbilirubinaemic patients had higher total cholesterol and lower high density lipoprotein (HDL) cholesterol levels (p<0.001). With time, disease progression was associated with a reduction in total (p<0.001) and HDL (p<0.05) cholesterol. The incidence of cardiovascular events was similar to that of the general population (cerebrovascular events: standardised ratio 1.4; 95% confidence interval 0.5-3.7; coronary events: 2.2; 0.9-4.3). Hypertension was associated with an increased risk of cardiovascular events (3.8; 1.6-8.9). Association with moderate hypercholesterolaemia was of borderline significance (3.8; 0.9-17) whereas severe hypercholesterolaemia was not associated with increased risk (2.4, 0.5-11). Conclusions: In PBC, serum cholesterol levels markedly increase with worsening of cholestasis, and decrease in the late disease stages, despite a severe reduction in biliary secretion. Marked hypercholesterolaemia, typical of severe longstanding cholestasis, is not associated with an excess risk of cardiovascular disease while less advanced patients with moderate hypercholesterolaemia are exposed to an increased cardiovascular risk. Putative protective factors in PBC patients with severe hypercholesterolaemia should be assessed.

Original languageEnglish (US)
Pages (from-to)265-269
Number of pages5
JournalGut
Volume51
Issue number2
DOIs
StatePublished - 2002
Externally publishedYes

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Biliary Liver Cirrhosis
Hypercholesterolemia
Cholesterol
Cholestasis
Serum
Cardiovascular Diseases
Lipids
HDL Lipoproteins
HDL Cholesterol
Population
Disease Progression
Liver Diseases
Confidence Intervals
Hypertension
Incidence

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Longo, M., Crosignani, A., Battezzati, P. M., Squarcia Giussani, C., Invernizzi, P., Zuin, M., & Podda, M. (2002). Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis. Gut, 51(2), 265-269. https://doi.org/10.1136/gut.51.2.265

Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis. / Longo, M.; Crosignani, A.; Battezzati, P. M.; Squarcia Giussani, C.; Invernizzi, P.; Zuin, M.; Podda, Mauro.

In: Gut, Vol. 51, No. 2, 2002, p. 265-269.

Research output: Contribution to journalArticle

Longo, M, Crosignani, A, Battezzati, PM, Squarcia Giussani, C, Invernizzi, P, Zuin, M & Podda, M 2002, 'Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis', Gut, vol. 51, no. 2, pp. 265-269. https://doi.org/10.1136/gut.51.2.265
Longo M, Crosignani A, Battezzati PM, Squarcia Giussani C, Invernizzi P, Zuin M et al. Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis. Gut. 2002;51(2):265-269. https://doi.org/10.1136/gut.51.2.265
Longo, M. ; Crosignani, A. ; Battezzati, P. M. ; Squarcia Giussani, C. ; Invernizzi, P. ; Zuin, M. ; Podda, Mauro. / Hyperlipidaemic state and cardiovascular risk in primary biliary cirrhosis. In: Gut. 2002 ; Vol. 51, No. 2. pp. 265-269.
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abstract = "Background: Primary biliary cirrhosis (PBC), a chronic cholestatic liver disease, is frequently associated with severe hypercholesterolaemia but the clinical significance of this finding is unclear. Aims: To characterise changes in serum lipid profile over time and to assess the risk of cardiovascular disease in PBC. Subjects and methods: We studied a cohort of 400 PBC patients for 6.2 years (range 4 months to 24 years) by serial determinations of serum lipid levels and registration of all cardiovascular events. Subjects included in an Italian prospective population based study served as controls. Results: At presentation, 76{\%} of patients had serum cholesterol levels >5.2 mmol/l. Hyperbilirubinaemic patients had higher total cholesterol and lower high density lipoprotein (HDL) cholesterol levels (p<0.001). With time, disease progression was associated with a reduction in total (p<0.001) and HDL (p<0.05) cholesterol. The incidence of cardiovascular events was similar to that of the general population (cerebrovascular events: standardised ratio 1.4; 95{\%} confidence interval 0.5-3.7; coronary events: 2.2; 0.9-4.3). Hypertension was associated with an increased risk of cardiovascular events (3.8; 1.6-8.9). Association with moderate hypercholesterolaemia was of borderline significance (3.8; 0.9-17) whereas severe hypercholesterolaemia was not associated with increased risk (2.4, 0.5-11). Conclusions: In PBC, serum cholesterol levels markedly increase with worsening of cholestasis, and decrease in the late disease stages, despite a severe reduction in biliary secretion. Marked hypercholesterolaemia, typical of severe longstanding cholestasis, is not associated with an excess risk of cardiovascular disease while less advanced patients with moderate hypercholesterolaemia are exposed to an increased cardiovascular risk. Putative protective factors in PBC patients with severe hypercholesterolaemia should be assessed.",
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AU - Crosignani, A.

AU - Battezzati, P. M.

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AU - Zuin, M.

AU - Podda, Mauro

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