Metabolic syndrome associated with primary biliary cirrhosis

Abstract

Introduction: Primary biliary cirrhosis (PBC) is characterized by a long natural history and a low incidence of cardiovascular events despite high serum cholesterol levels. The role of any metabolic conditions (obesity, hypertension, diabetes) in association with PBC has not been analyzed, however.

Aim: : To assess the influence of metabolic syndrome (MS) on response to ursodeoxycholic acid (UDCA) and the survival in PBC patients.

Methods: The historical database (1975 to 2011) comprising consecutively enrolled PBC patients with a mean follow-up of 123 months (range, 12 to 425 mo) was used. All patients were treated with UDCA (15 mg/kg/d). Responders to UDCA were defined as patients achieving at least a 40% drop in their alkaline phosphatase levels after 1 year. MS was defined according to the American Heart Association criteria. Survival was analyzed by means of Kaplan-Meier curves.

Results: A total of 171 PBC patients were eligible for the study; 55 of them (32.1%) fulfilled the criteria for MS at presentation. Liver function tests and Mayo score were found comparable in PBC patients with and without MS. Histologic stages were similar in the 2 groups at the baseline. Significantly more cardiovascular events occurred in patients with MS during the follow-up (P<0.0001). Response to UDCA was greater in the group without MS, but the difference was not statistically significant. The Kaplan-Meier curves were similar in the 2 groups.

Conclusions: When associated with MS, PBC should be monitored carefully due to the risk of cardiovascular events.