P4683 - Predictors of Major Adverse Cardiovascular Events in Patients With Primary Biliary Cholangitis

Prajwal Gowda, BS¹, Meena M. Tadros, BS¹, Marlyn J. Mayo, MD, FACG², Mark Pedersen, MD^1
1University of Texas Southwestern Medical Center, Dallas, TX; ²University of Texas Southwestern, Dallas, TX

Introduction: Primary Biliary Cholangitis (PBC) is an autoimmune, cholestatic liver disease that is associated with hypercholesterolemia. Recommendations for the use of lipid-lowering therapies to reduce the burden of cardiovascular disease have been equivocal. With the earlier diagnosis and ever-increasing treatment options, patients with PBC are living longer with earlier stage disease. We examine the effect of hypercholesterolemia and statins in a more modern cohort of patients with PBC who have earlier stage disease.

Methods: A retrospective cohort study was composed of two patient cohorts: (1) a historical cohort from the multi-center trial of methotrexate versus placebo added to therapy with UDCA (NIH RO1 DK46602) and (2) all patients at our institution diagnosed with PBC who were seen from 2002 to 2022. Historical, laboratory, and outcome data was collected on all patients to evaluate factors predictive and protective of MACE, defined as ST-elevation / non-ST elevation myocardial infarction, unstable angina requiring percutaneous coronary intervention, cerebrovascular accident, or transient ischemic attack.

Results: A total of 149 individuals were included in the study, with 9 MACE events recorded. Patients with a MACE had a higher frequency of diabetes (33.3% v 4.2%, p = 0.01), hypertension (66.7% v 25.5%, p = 0.02), and had a lower HDL (mean 50.6 mg/dL v 63.2 mg/dL, p = 0.002) at the time of diagnosis of PBC. On multivariable cox-regression analysis, a diagnosis of hypertension or diabetes (both p < 0.05) predicted MACE in the 5 years preceding the event. Kaplan-Meyer survival analysis of patients with hypertension, diabetes, and a low-density lipoprotein (LDL) > 190 mg/dL (all p < 0.05) showed patients treated with a statin have a lower risk of MACE compared to untreated patients (Figure 1).

Discussion: Diabetes and hypertension are predictors of MACE in patients with PBC. Though hypercholesterolemia was not predictive with MACE in our study, statins were protective against MACE in patients with diabetes, hypertension, and LDL > 190 mg/dL. Our study is limited by a small sample size and relatively few primary outcomes. Further studies should more closely examine the effect of hypercholesterolemia and lipid-lower therapies on MACE in patients with PBC.



Disclosures:


Prajwal Gowda, BS¹, Meena M. Tadros, BS¹, Marlyn J. Mayo, MD, FACG², Mark Pedersen, MD¹. P4683 - Predictors of Major Adverse Cardiovascular Events in Patients With Primary Biliary Cholangitis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.