Bottom line: Hyperlipidemia in patients with PBC does not appear to be associated with an increased risk of cardiovascular events. Family history of hyperlipidemia and/or cardiovascular disease is another factor to consider in deciding on medical treatment of hyperlipidemia in these patients. In patients in whom treatment for hyperlipidemia associated with PBC is considered, limited data suggests that use of statins in these individuals is probably safe.
Summary: AASLD PBC guidelines briefly discussed several retrospective studies of patients with PBC and hyperlipidemia reporting no increase in rates of cardiovascular events in these patients. The guidelines do indicate that it is reasonable to consider family history in deciding on medical treatment of hyperlipidemia in these patients.
The findings of these studies are replicated in this retrospective study: Solaymani-Dodaran M, et al. Risk of cardiovascular and cerebrovascular events in primary biliary cirrhosis: a population-based cohort study. Am J Gastroenterol. 2008 Nov;103(11):2784-8. doi: 10.1111/j.1572-0241.2008.02092.x.
PBC cases (n=930) were compared to controls (n=9,202) matched for age, sex and general practice. Here are baseline characteristics:
Hyperlipidemia: PBC, 91%; controls, 94%
No prescription for lipid-lowering drugs: PBC, 95%; controls, 95%
hypertension: PBC, 25%; controls, 27%
diabetes: PBC, 9%; controls, 6%
RESULTS: During 43,700 person-years of follow up, rates of cardiovascular events were not siginificantly different between the two groups:
MI: PBC, 5.9/1000; controls, 5.6/1,000
Stroke: PBC, 13.8/1000; controls, 14.0/1,000
TIA: PBC, 3.5/1000; controls, 5.3/1000
Hazard ratio for PBC group compared to control group:
For any CV event: 0.99 (95% CI 0.77–1.27)
For MI: 1.04 (95% CI 0.67–1.62)
For stroke: 0.98 (95% CI 0.73–1.31)
For TIA: 0.66 (95% CI 0.38–1.16)