Study Finds HCV Infection Increases 10-Year Risk of Cardiovascular Disease

A combined analysis of data gathered from the Canadian Health Measures Survey (CHMS) and the US—National Health and Nutrition Examination Survey (NHANES) found a 2.5% to 3.5% increase in the 10-year risk of cardiovascular disease (CVD) in patients with a hepatitis C virus (HCV) infection.

In addition to liver complications, such as fibrosis, cirrhosis, liver cancer, and liver failure, HCV infection has also been found responsible for extrahepatic complications that affect the hematologic, neurologic, and renal functions. Several studies have also documented cause-specific cardiovascular mortality in patients who are positive for HCV.^1,2

The current cross-sectional study included 10,115 participants from CHMS (2007-2015) and 16,668 participants from NHANES (2007-2016), who were between 30 and 74 years old and had no prior history of CVD.³ A Framingham Risk Score (FRS) algorithm was developed for this population. Exclusion criteria also included missing data on any of the required FRS data: age, gender, blood pressure, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), smoking status, diabetes, and antihypertensive medication. Lack of information on HCV status was also an exclusion criterium.

HCV-positive participants had a very distinct sociodemographic profile, but cardiometabolic risk factors, inflammatory markers, and serum levels of micronutrients were comparable with the HCV-negative population. Additionally, the HCV-positive participants had a significantly higher rate of intravenous recreational drug use in both the NHANES (33% vs 1%) and CHMS (53% vs 1%) populations.

HCV-positive participants had significantly lower levels of triglycerides, low-density lipoprotein cholesterol, TC:HDL-C, and ApoB, compared with the noninfected controls. In the CHMS group, viral infection was associated with higher TC (4.50 ± 0.97 vs 3.94 ± 1.27 mmol/L; P <.001), as opposed to the HCV-positive NHANES participants, who had lower TC (4.67 ± 1.0 vs 5.17 ± 1.1 mmol/L; P <.001). There was no association between HCV status and diabetes (either self-reported or glycated hemoglobin levels).

Liver enzyme levels were much higher in the presence of active HCV infection, unsurprisingly, and FRS value among the HCV-positive NHANES participants was much higher in the HCV RNA-positive cases (15.3% ± 10.4%; P = .047) compared with the HCV-negative cases (12.1% ± 9.8%). HCV-positive cases had a significantly higher 10-year risk of CVD in both the NHANES (14.7 ± 10.3 vs 10.0 ± 10.0; P <.001) and CHMS (10.5 ± 8.8 vs 8.0 ± 6.6; P = .008) groups. Interestingly, the overall CVD risk was higher in the US population, independent of their infection status.

HCV-infected individuals in the NHANES population had a 4.21% (P <.001) greater 10-year CVD risk compared with the noninfected population. Similarly, the HCV-positive CHMS US population (3.5%; P <.001) had a greater risk compared with the Canadian population (2.5%; P <.003).

“The expansion of anti-HCV therapy may also contribute to reduced CVD risk and burden in patients with chronic HCV infection and should be explored further in other datasets and population modelling studies,” the authors conclude.

References

1. Kristiansen MG, Løchen ML, Gutteberg TJ, Mortensen L, Eriksen BO, Florholmen J. Total and cause-specific mortality rates in a prospective study of community-acquired hepatitis C virus infection in northern Norway. J Viral Hepat. 2011;18(4):237-244. doi: 10.1111/j.1365-2893.2010.01290.x.

2. Lee MH, Yang HI, Wang CH, et al. Hepatitis C virus infection and increased risk of cerebrovascular disease. Stroke. 2010;41(12):2894-900. doi: 10.1161/STROKEAHA.110.598136.

3. Badawi A, Di Giuseppe G, Arora P. Cardiovascular disease risk in patients with hepatitis C infection: results from two general population health surveys in Canada and the United States (2007-2017). PLoS One. 2018;13(12):e0208839. doi: 10.1371/journal.pone.0208839.