Abstract
Introduction: Cardiovascular disease (CVD) remains a leading cause of death in women. Atherosclerotic Cardiovascular Disease score does not encompass inflammatory diseases, which is associated with increased CVD risk. This score may underestimate risk in women with autoimmune liver diseases (AILD) such as autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC). We investigated if women with AILD had increased CVD risk compared to female and male controls.
Methods: Using TriNetX, we conducted a multi-center, retrospective cohort study of patients with AIH, PBC, and PSC. Study cohorts were females with respective AILD who had diabetes mellitus (DM), hypertension (HTN), and lipidemia. Control cohorts were female or male with DM, HTN, and lipidemia with AILD, biologics, immune modulators, and steroids explicitly excluded. Female study versus female control were matched for age, race, ethnicity, ASCVD risk factors, and tobacco use. Female study versus male control were matched for age, race, ethnicity, and tobacco use. Primary outcome was summative cardiovascular (CV) risk including unstable angina, acute myocardial infarction, and presence of coronary angioplasty implant, coronary artery bypass, percutaneous coronary intervention, and cerebral infarction.
Results: Females with AIH had greater CV risk compared to control females (24.7% vs. 18.9%, P-value<0.0001), which was seen with PBC (24.9% vs. 18.4%, P-value<0.0001). There was no difference for PSC (26.4% vs. 20.7%, P-value=0.26).
When comparing to male controls, females with AIH did not have significant CV risk (24.7% vs. 22.4%, P-value=0.10), also seen in PBC (24.9% vs. 23.9%, P-value=0.53), and PSC (26.2% vs. 17.7%, P-value=0.08).
Conclusion: Females with AIH and PBC lose CV protection conferred by female sex. There is no difference in CV risk in females with AILD compared to male controls. There is a potential oversight in our risk stratification approach to females with chronic AILD. Enhancing risk assessment is imperative for optimizing patient outcomes.
Keywords
Autoimmune, Cardiovascular disease, Cardiac risk, Liver disease, Sex difference