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

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). 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). 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). 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.