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Sunday Poster Session

Category: Liver

P0939 - A 5-Year National Inpatient Sample Analysis of Atherosclerotic Disease in Patients With Primary Biliary Cholangitis

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall
Het Patel, DO1, Spandan Desai, MD2, Hammad Liaquat, MD3
1St. Luke's University Health Network, Bethlehem, PA; 2St. Luke's University Health Network, Bethlehem, OR; 3St. Luke's University Health Network, Bethlehem, PA

Introduction: Primary Biliary Cholangitis (PBC) is associated with hypercholesteremia due to the decrease in LDL receptors and elevated lipoprotein-X. Studies have also shown that these patients do not have an elevated risk for atherosclerotic events and are recommended to be risk stratified based on other risk factors. The aim of this study is to assess the risk of atherosclerotic events using national data in patients with PBC and known ASCVD risk factors.

Methods: This is a retrospective cohort study using National Inpatient Sample data including patients hospitalized between 2016 and 2020 with known ASCVD risk factors including age 40 or more, history of smoking, diabetes mellitus, and hypertension. The primary outcome measured was inpatient complications related to atherosclerotic disease. Statistical analyses were all performed using STATA software.

Results: Of the 6,191,119 patients who met our inclusion criteria, 2,040 had a history of PBC of which 82.1% were female, and 71.1% were white with a mean age 67.1 versus 64.9 in the group without PBC. Of the demographics assessed, gender, Black race, obesity, and drug use showed a statistically significant relationship (p< 0.05) between the two groups. Patients with PBC were less likely to develop coronary artery disease (p= <0.001, OR= 0.631; 95% CI 0.503-0.791), acute coronary syndrome (p=0.019, OR= 0.405; 95% CI 0.185-0.886), and stroke (p=0.026, OR= 0.480; 95% CI 0.249-0.927) compared to patients without PBC. Patients with PBC did not have a statistically significant risk (p >0.05) of critical limb ischemia, cerebrovascular disease, or aortic aneurysm.

Discussion: Although PBC is associated with hypercholesterolemia, the data shows that PBC is protective for coronary artery disease, acute coronary syndrome, and stroke in patients who have had atherosclerotic risk factors and equivocal risk for critical limb ischemia, cerebrovascular disease, and aortic aneurysm. This study does not consider whether or not patients are being treated for hypercholesterolemia however this study does not show an association with any of the atherosclerotic diseases studied which may help guide treatment especially in patients who cannot tolerate a statin due to PBC. To our knowledge, this is the first national database research assessing atherosclerotic disease in patients with ASCVD risk factors that supports existing literature about lower atherosclerotic disease in this cohort.
 
 
 
 
 
 

 

 
 
 
 

Patients with PBC 

(n = 2040) 

 
 
 
 

Patients without PBC 

(n = 6189079) 

 
 
 
 

p-value 

 

 
 
 
 

Demographics  

 
 
 
 

Mean Age, years 

 
 

67.1 

 
 

64.9 

 
 

< 0.001 

 
 
 
 

Gender, n  

     Male 

     Female 

 
 

 

365 (17.9%) 

1675 (82.1%) 

 
 

 

3580395 (57.9%) 

2607620 (42.1%) 

 
 

 

< 0.001 

 
 
 
 

Race, n  

    White 

    Black 

    Hispanic 

    Asian or Pacific Islander 

    Native American 

    Other 

 
 

 

1450 (71.1%) 

245 (12.0%) 

200 (9.8%) 

55 (2.7%) 

5 (0.3%) 

35 (1.7%) 

 
 

 

4208854 (68.0%) 

983715 (15.9%) 

529165 (8.6%) 

106320 (1.7%) 

49640 (0.8%) 

143090 (2.3%) 

 
 

 

0.202 

0.038 

0.383 

0.153 

0.207 

0.421 

 
 
 
 

 

 
 
 
 

Comorbidities 

 
 
 
 

Obesity Class, n  

    Class 1 

    Class 2 

    Class 3 

 
 

 

80 (3.9%) 

55 (2.7%) 

140 (6.9%) 

 
 

 

401120 (6.5%) 

389620 (6.3%) 

609415 (9.9%) 

 
 

 

0.036 

0.003 

0.042 

 
 
 
 

Congestive Heart Failure, n  

 
 

115 (5.6%) 

 
 

513485 (8.3%) 

 
 

0.052 

 
 
 
 

COPD, n  

 
 

480 (23.5%) 

 
 

1723810 (27.9%) 

 
 

0.050 

 
 
 
 

Cirrhosis, n  

 
 

100 (4.9%) 

 
 

211445 (3.4%) 

 
 

0.097 

 
 
 
 

ESRD, n 

 
 

0 (0.0%) 

 
 

13925 (0.2%) 

 
 

0.369 

 
 
 
 

Alcohol Abuse, n  

 
 

100 (4.9%) 

 
 

460785 (7.5%) 

 
 

0.050 

 
 
 
 

Drug Use, n 

 
 

80 (3.9%) 

 
 

422835 (6.8%) 

 
 

0.020 

 
 
 
 

Cancer, n  

 
 

150 (7.4%) 

 
 

408700 (6.6%) 

 
 

0.543 

 
 
 
 

Metastatic Cancer, n 

 
 

65 (3.2%) 

 
 

249770 (4.0%) 

 
 

0.416 

 
 
 
 

Lymphoma, n  

 
 

5 (0.3%) 

 
 

56120 (0.9%) 

 
 

0.159 

 
 
 
 

Dementia, n 

 
 

105 (5.2%) 

 
 

343310 (5.6%) 

 
 

0.723 

 
 
 
 

Malnutrition, n 

 
 

60 (2.9%) 

 
 

166085 (2.7%) 

 
 

0.747 

 
 
 
 

 

 
 
 
 

Mortality, n 

 
 

35 (1.7%) 

 
 

96505 (1.6%) 

 
 

0.795 

 
 
 
 

 

 
 
 
 

Atherosclerotic Diseases 

 
 
 
 

Critical Limb Ischemia, n 

 
 

5 (0.3%) 

 
 

30065 (0.5%) 

 
 

0.485 

 
 
 
 

CAD, n 

 
 

475 (23.5%) 

 
 

2010305 (32.5%) 

 
 

< 0.001 

 
 
 
 

ACS, n 

 
 

40 (2.0%) 

 
 

290950 (4.7%) 

 
 

0.019 

 
 
 
 

Cerebrovascular Disease, n  

 
 

175 (8.6%) 

 
 

712015 (11.5%) 

 
 

0.063 

 
 
 
 

Stroke, n

 
 

45 (2.2%) 

 
 

277745 (4.5%) 

 
 

0.026 

 
 
 
 

Aortic Aneurysm, n 

 
 

0 (0.0%) 

 
 

3760 (0.1%) 

 
 

0.627 


Table: Patient demographics, comorbidities, mortality, and atherosclerotic disease.
Abbreviations: COPD = Chronic Obstructive Pulmonary Disease, CAD = Coronary Artery Disease, ACS = Acute Coronary Syndrome


Disclosures:
Het Patel indicated no relevant financial relationships.
Spandan Desai indicated no relevant financial relationships.
Hammad Liaquat indicated no relevant financial relationships.


Het Patel, DO1, Spandan Desai, MD2, Hammad Liaquat, MD3. P0939 - A 5-Year National Inpatient Sample Analysis of Atherosclerotic Disease in Patients With Primary Biliary Cholangitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.