Low-dose atorvastatin improves dyslipidemia and vascular function in patients with primary biliary cirrhosis after one year of treatment



      Primary biliary cirrhosis (PBC) is frequently associated with hypercholesterolemia and with an increased cardiovascular morbidity and mortality. Statins lower serum cholesterol levels and may thus improve the cardiovascular risk in PBC patients. The aim of our study was to prospectively examine the efficacy of low-dose atorvastatin on cholestasis as well as cardiovascular risk markers such as dyslipidemia and vascular function in patients with PBC.


      Nineteen patients with early-stage (biopsy proven and AMA positive) PBC and low-density lipoprotein cholesterol (LDL-C) above 130 mg/dL were included in this single-center study and treated with atorvastatin 10 mg per day for one year.


      Concentrations of total cholesterol, LDL-C, LDL triglycerides, oxLDL, IgG and sVCAM-1 decreased significantly after 48 weeks of atorvastatin treatment. Flow-mediated dilation (FMD) of the brachial artery as an indicator of vascular function significantly increased, while carotid artery intima-media thickness and vascular wall stiffness did not progress under treatment. No statistical differences in liver enzymes were observed except a transient increase of alkaline phosphatase.


      Treatment with low-dose atorvastatin is safe in early-stage PBC, effectively reduces total cholesterol, LDL-C, LDL triglycerides, oxLDL and sVCAM-1 and improves vascular function as reflected by FMD, without affecting cholestasis progression. Therefore, statin therapy should be considered in PBC patients with additional risk factors for cardiovascular disease.


      ALT (alanine aminotransferase), AP (alkaline phosphatase), AST (aspartate aminotransferase), AMA (anti-mitochondrial antibodies), CK (creatine phosphokinase), CRP (C-reactive protein), FMD (flow-mediated dilation of the brachial artery), GGT (gamma-glutamyl transferase), HDL-C (high-density lipoprotein cholesterol), IMT (intima-media thickness), LDL-C (low-density lipoprotein cholesterol), NAFLD (nonalcoholic fatty liver disease), oxLDL (oxidized LDL), PBC (primary biliary cirrhosis), sICAM-1 (soluble intercellular adhesion molecule-1), sVCAM-1 (soluble vascular cell adhesion molecule-1), UDCA (ursodeoxycholic acid), ULN (upper limit of normal)


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