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Background and aims <p>This large-scale, real-world study aimed to determine if high-intensity hydrophilic or high-intensity lipophilic statins more optimally reduced the incidence of all-cause mortality, all-cause hospitalization, cardiovascular, liver, and symptom-related outcomes over a 5-year follow-up period in patients with Primary biliary cholangitis (PBC).</p> Methods <p>We conducted a retrospective, propensity score matched cohort study using the TriNetX Research Network, comparing PBC patients receiving high-intensity hydrophilic (rosuvastatin ≥ 20&#xa0;mg) versus high-intensity lipophilic (atorvastatin ≥ 40&#xa0;mg) statins (778 patients per group).</p> Results <p>High-intensity hydrophilic and high-intensity lipophilic statins did not differ in all-cause mortality (HR, 0.960 [95% CI, 0.710–1.296]; <i>p</i> = 0.788), major adverse cardiovascular events (MACE) (HR, 0.870 [95% CI, 0.740–1.023]; <i>p</i> = 0.091), liver, symptom-related, or the majority of cardiovascular outcomes (all <i>p</i>-values &gt; 0.05). However, high-intensity hydrophilic statins showed significant advantages over high-intensity lipophilic statins in all-cause hospitalizations (HR, 0.595 [95% CI, 0.497–0.713]; <i>p</i> &lt; 0.001) and cerebral infarction (HR, 0.400 [95% CI, 0.224–0.712]; <i>p</i> = 0.001).</p> Conclusions <p>In PBC patients requiring high-intensity statin therapy, hydrophilic statins provide equivalent survival with significant advantages in all-cause hospitalization reduction (40% decrease) and stroke prevention (60% decrease). These results support the preferential use of hydrophilic statins for lipid-lowering therapy in PBC while still acknowledging that both classes represent suitable therapeutic options.</p>

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High-intensity hydrophilic versus lipophilic statins in patients with primary biliary cholangitis: a multi-institutional analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月10日

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  • Hussam Kawas,
  • Mohammad Alabbas,
  • Mohamad-Noor Abu-Hammour,
  • Barish Eren,
  • Walid Hazem,
  • Omar T. Sims,
  • Dian-Jung Chiang

摘要

Background and aims

This large-scale, real-world study aimed to determine if high-intensity hydrophilic or high-intensity lipophilic statins more optimally reduced the incidence of all-cause mortality, all-cause hospitalization, cardiovascular, liver, and symptom-related outcomes over a 5-year follow-up period in patients with Primary biliary cholangitis (PBC).

Methods

We conducted a retrospective, propensity score matched cohort study using the TriNetX Research Network, comparing PBC patients receiving high-intensity hydrophilic (rosuvastatin ≥ 20 mg) versus high-intensity lipophilic (atorvastatin ≥ 40 mg) statins (778 patients per group).

Results

High-intensity hydrophilic and high-intensity lipophilic statins did not differ in all-cause mortality (HR, 0.960 [95% CI, 0.710–1.296]; p = 0.788), major adverse cardiovascular events (MACE) (HR, 0.870 [95% CI, 0.740–1.023]; p = 0.091), liver, symptom-related, or the majority of cardiovascular outcomes (all p-values > 0.05). However, high-intensity hydrophilic statins showed significant advantages over high-intensity lipophilic statins in all-cause hospitalizations (HR, 0.595 [95% CI, 0.497–0.713]; p < 0.001) and cerebral infarction (HR, 0.400 [95% CI, 0.224–0.712]; p = 0.001).

Conclusions

In PBC patients requiring high-intensity statin therapy, hydrophilic statins provide equivalent survival with significant advantages in all-cause hospitalization reduction (40% decrease) and stroke prevention (60% decrease). These results support the preferential use of hydrophilic statins for lipid-lowering therapy in PBC while still acknowledging that both classes represent suitable therapeutic options.