Serum lipids in primary sclerosing cholangitis

Background: Limited data are available regarding the serum lipids in primary sclerosing cholangitis. Aims: To determine the lipid levels in patients with primary sclerosing cholangitis. Methods: We monitored the serum lipid levels annually for up to 6 years in 157 patients included in three previous trials of ursodeoxycholic acid. Results: The baseline lipid values were: total cholesterol = 207mg/dL (127-433); high-density lipoprotein = 56mg/dL (26-132); low-density lipoprotein =129. mg/dL (48-334); triglycerides = 102. mg/dL (41-698). Cirrhotic stage was associated with lower levels of total cholesterol (186. mg/dL vs. 217. mg/dL, p=.02). A significant correlation between the liver biochemistries and total and low-density lipoprotein cholesterol levels was observed. Ursodeoxycholic acid, as compared to placebo, significantly decreased total (-27. mg/dL vs. 22. mg/dL, p=.0004) and low-density lipoprotein cholesterol (-24. mg/dL vs. 17. mg/dL, p=.0001). After extended follow-up, small changes in the lipid levels were noticed. The incidence of coronary artery disease was 4%. Conclusions: Our findings suggest that the lipid levels in primary sclerosing cholangitis are often above levels where treatment with lipid-lowering agents is recommended. However, primary sclerosing cholangitis patients seem to have no elevated risk for cardiovascular events. The correlation of total and low-density lipoprotein cholesterol with liver biochemistries implies that mechanisms linked to cholestasis may regulate cholesterol metabolism.