Cardiovascular Risk Assessment in Children with Chronic Cholestatic Liver Diseases.

OBJECTIVES Chronic cholestatic liver diseases are often associated with disturbed lipid metabolism, which may potentially increase cardiovascular (CV) risk, but the evidence is scarce. The aim of the study was to assess factors associated with increased CV risk in children with Alagille syndrome (AGS) and biliary atresia (BA). METHODS We investigated 17 patients with AGS aged 11.0y (8.4-13.4) and 19 with BA aged 13.5y (10.4-15.1) in whom we performed thorough biochemical assessment including lipid profiles and oxidative stress biomarkers, blood pressure (BP)- systolic, diastolic and mean, carotid intima-media-thickness (cIMT) and pulse wave velocity (PWV). RESULTS There were abnormal lipid profiles in 82% of children with AGS and 52.6% with BA. In AGS group we observed significantly higher levels of TC, LDL C, APO B, lower glutathione concentration and glutathione peroxidase activity and lower blood pressure, lower cIMT (p = 0.02), cIMT-SDS (p = 0.04) and PWV (p = 0.04). However, we observed elevated blood pressure in 2/19 patients with BA and none-with AGS (BA vs AGS: p = 0.12), while cIMT-SDS was increased only in 2/17 patients with AGS and in 6/19 with BA (p = 0.24) and abnormal PWV-SDS values were detected in 3/17 of AGS and 8/19 of BA patients (p = 0.15). Neither presence of dyslipidemia nor Lp-X correlated with vascular parameters. CONCLUSIONS Children with BA and AGS may present with increased cardiovascular risk factors but vascular parameters are not directly related to lipid abnormalities. cIMT and BP should be considered for clinical practice in these cholestatic disorders so as to determine individuals with potential CV risk.