Suraweera Duminda, Fanous Christina, Jimenez Melissa, Tong Myron J, Saab Sammy
Department of Medicine, Olive-View Medical Center, Sylmar, CA, USA.
Department of Surgery at the University of California at Los Angeles, Los Angeles, CA, USA.
J Clin Transl Hepatol. 2018 Jun 28;6(2):119-126. doi: 10.14218/JCTH.2017.00064. Epub 2018 Feb 14.
Hypercholesterolemia is a common finding in patients with primary biliary cholangitis (PBC) and is a well-defined risk factor for cardiovascular disease. However, studies have been mixed on whether PBC patients do, in fact, have higher cardiovascular risk. The aim of this study is to review the current literature and provide an evidence-based assessment of cardiovascular risk in PBC patients. We performed a systematic literature search on PubMed regarding patients with PBC and cardiovascular events from the database inception to July 1, 2017. A total of 33 articles fulfilling our inclusion criteria were found. The majority of the studies evaluated yielded no statistically significant difference in cardiovascular disease in the PBC population compared to the general public. However, some reports found a statistically significantly increase in coronary artery disease. Several studies have looked at the specific lipid profile of patients with PBC with hypocholesteremia. While these lipid abnormalities differ by stage of disease, there is evidence to suggest that the specific lipid profile in PBC may have lower atherogenicity than in patients with hypercholesterolemia without PBC. Studies looking at patients with PBC with other risk factors for cardiovascular disease, such as hypertension and metabolic syndrome, have consistently found a higher risk for cardiovascular disease in these patients. Statin treatment is effective in reducing lipid levels and possibly improving endothelial inflammation in patients with PBC with hypercholesterolemia. There is not enough evidence to suggest an increased risk of cardiovascular disease in patients with PBC with hypercholesterolemia, except for those individuals with concomitant features of metabolic syndrome. In patients with PBC with no additional cardiovascular risk factors, individual risk/benefit discussion on lipid-lowering treatment should be considered.
高胆固醇血症是原发性胆汁性胆管炎（PBC）患者的常见表现，并且是明确的心血管疾病危险因素。然而，关于PBC患者是否确实具有更高的心血管疾病风险，各项研究结果不一。本研究的目的是回顾当前文献，并对PBC患者的心血管疾病风险进行基于证据的评估。我们在PubMed上进行了系统的文献检索，涵盖从数据库建立至2017年7月1日期间患有PBC和心血管事件的患者。共找到33篇符合我们纳入标准的文章。大多数评估研究发现，与普通人群相比，PBC患者群体中心血管疾病并无统计学上的显著差异。然而，一些报告发现冠状动脉疾病有统计学上的显著增加。几项研究关注了患有低胆固醇血症的PBC患者的特定血脂谱。虽然这些血脂异常因疾病阶段而异，但有证据表明，PBC患者的特定血脂谱可能比无PBC的高胆固醇血症患者具有更低的致动脉粥样硬化性。针对患有心血管疾病其他危险因素（如高血压和代谢综合征）的PBC患者的研究一致发现，这些患者患心血管疾病的风险更高。他汀类药物治疗对于降低患有高胆固醇血症的PBC患者的血脂水平并可能改善内皮炎症有效。除了那些伴有代谢综合征特征的个体外，没有足够的证据表明患有高胆固醇血症的PBC患者心血管疾病风险增加。对于没有其他心血管危险因素的PBC患者，应考虑就降脂治疗进行个体风险/获益的讨论。
