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

Has Audio

Presenting Author(s)

Het Patel, DO

St. Luke's University Health Network
Bethlehem, PA

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.