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Meeting an Unmet Need: Assessing Cardiovascular Risk in Hepatitis C

Meeting an Unmet Need: Assessing Cardiovascular Risk in Hepatitis C

Within the hepatitis C patient and scientific communities, there are several unmet needs related to the possible association of the hepatitis C virus (HCV) with morbidity and mortality. One topic that has been of recent interest in the community is whether HCV is an independent risk factor for cardiovascular disease (CVD) and CVD-related mortality. A number of recently published studies have demonstrated a strong link between HCV and a higher risk of CVD.

This topic was recently addressed with a poster presentation during the 50th International Liver Congress in April 2015. Firew Wubiee, MD and colleagues at Howard University primarily aimed to explore the association of HCV infection and cardiovascular events. HCV infection is associated with several comorbidities, including insulin resistance, diabetes, and systemic inflammation, which may ultimately lead to cardiovascular events. The authors used data from the 2011 Nationwide Inpatient Sample database to study patients with HCV infections. The NIS is the largest all-payer inpatient care database in the Unites States with data on more than 7 million hospital stays. Patients were identified for the study if they had a cardiovascular event. In the study, there were 201,950 patients with acute myocardial infarction, 1,454,012 patients with coronary artery disease, 944,870 patients with congestive heart failure, and 53,623 patients with a cerebrovascular accident.

The investigators determined a 1.9% inpatient prevalence of diagnosed HCV infection. Of the patients with HCV infection, the adjusted odds ratio was 2.29 for acute myocardial infarction, 1.88 for coronary artery disease, 1.98 for cerebrovascular accident, and 1.09 for congestive heart failure. They also found that patients with HCV infection were more likely to be younger, poorer, male, smokers, alcohol consumers, diabetic, minorities, and more likely to die in the hospital compared to those without diagnosed HCV. According to the study abstract, the authors concluded that HCV is associated with a higher risk of developing a cardiovascular outcome and should be considered a cardiovascular risk factor.

In a more recently published study, Salvatore Petta and colleagues conducted a meta-analysis of observational studies. The authors analyzed 22 studies published through July 2015. These studies compared the prevalence of CVD between HCV-infected and uninfected subjects or assessed the prevalence of HCV infection among subjects with CVDs.

The researchers found that compared to uninfected patients, the HCV-infected patients had increased risk of CVD-related mortality, carotid plaques, and cerebro-cardiovascular events (odds ratio 1.65, 2.27, and 1.30, respectively). Similar to Wubiee’s study, these researchers found a larger effect of HCV infection on cerebro-cardiovascular disease among patients with diabetes. They also reported similar effects on patients with hypertension. Petta and colleagues concluded that individuals with HCV infections were at an increased risk for CVD-related morbidity and mortality. In particular, HCV infections associated with CVD were more commonly found in people with diabetes or hypertension.

Both studies highlighted above found a link between HCV and cardiovascular risk. Previously published studies examining the link between the virus and risk factors for CVD have been inconclusive. As this topic becomes of more interest to the Hepatitis C community, more studies may be conducted to determine a conclusive association between HCV and CVD.1,2

  1. Wubiee F, Howell C. Hepatitis C infection is associated with an increase in cardiovascular diseases. J Hepatol. 2015;62:S612.
  2. Petta S, Maida M, Macaluso FS, Barbara M, et al. Hepatitis C virus infection is associated with increased cardiovascular mortality: a meta-analysis of observational studies. Gastroenterology. 2015;sep 16 [Epub ahead of print].