Highlights
- •HCV clearance by direct-acting antivirals (DAA) significantly reduces the annual incidence of cardio vascular events by 0.68%.
- •Incident cardiovascular events (CV) rates for 100 patient years in controls was 1.14 and in cases 0.44.
- •The CV risk after HCV clearance was reduced by 2.0–3.5 folds.
- •The calculated number of patients to be treated to get a benefit in a patient was 55.26.
- •HCV clearance was independently associated with CV events reduction.
Abstract
Background and aims
HCV is associated with an increased risk of cardiovascular events (CV). Whether HCV
clearance by direct-acting antivirals (DAA) reduces incident CV disease is poorly
understood. We investigate whether HCV eradication reduces CV events.
Methods
In a prospective multicentre study, 2204 HCV patients (F0–F2:29.5%, F3–F4: 70.5%)
were enrolled. Males were 48%, median age was 68 (59–74) years and BMI 25.9 (23.1–28);
24.7% were smokers, 18% had diabetes, 13.2% had cholesterol levels >200 mg/dl and
9.1% took statins, 44% had hypertension. During an overall median follow-up of 28
(24–39) months, incident CV events, such as ischemic heart disease (IHD) and ischemic
cerebral stroke (ICS), were recorded. An overall of 2204 patients were evaluated as
control group and 1668 patients after HCV elimination were followed as a case group.
Factors associated with CV events were evaluated by uni- and multi-variate analyses.
Results
Incident CV rates per 100 patient years in pre-treatment and untreated controls and
treated cases were 1.12, 1.14 and 0.44 (p = 0.0001 vs. controls), respectively, and a decreased of relative risk (RR = 0.379; p = 0.0002) was observed. CV risk was 2.0–3.5 times lower then in controls (HR 3.671;
95%C.I.:1.871–7.201; p < 0.001). The calculated number of patients to be treated to get a benefit in a patient
was 55.26. The annual incidence reduction of CV events was 0.68%. HCV clearance was
independently associated with CV events reduction (OR, 4.716; 95% C.I.:1.832–12.138;
p = 0.001).
Conclusions
HCV clearance by DAA reduces CV events (IHD and ICS) with both clinical and socio-economic
benefits.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to AtherosclerosisAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hepatitis C infection: a systemic disease.Clin. Liver Dis. 2017; 21: 449-453
- Chronic HCV infection is a risk of atherosclerosis. Role of HCV and HCV-related steatosis.Atherosclerosis. 2012; 221: 496-502
- Carotid atherosclerosis and chronic hepatitis C: a prospective study of risk associations.Hepatology. 2012; 55: 1317-1323
- Risk of acute myocardial infarction among hepatitis C virus (HCV)-Positive and HCV-negative men at various lipid levels: results from ERCHIVES.Clin. Infect. Dis. 2017; 65: 557-565
- Impact of hepatitis C seropositivity on the risk of coronary heart disease events.Am. J. Cardiol. 2014; 114: 1841-1845
- Myocardial injury in patients with chronic hepatitis C infection.J. Hepatol. 2013; 58: 11-15
- Risk of cardiac arrhythmias in patients with chronic hepatitis B and C infections - a 13-year nationwide population-based study.J. Cardiol. 2019 Apr 11; (pii: S0914-5087): 30081-30084
- Is hepatitis C associated with atherosclerotic burden? A systematic review and meta-analysis.PloS One. 2014; 9e106376
- Hepatitis C virus infection is associated with increased cardiovascular mortality: a meta-analysis of observational studies.Gastroenterology. 2016; 150: 145-155
- Chronic HCV infection is a risk factor of ischemic stroke.Atherosclerosis. 2013; 231: 22-26
- Does hepatitis C virus infection increase risk for stroke? A population-based cohort study.PloS One. 2012; 7e31527
- Hepatitis C virus infection and risk of stroke: a systematic review and meta-analysis.PloS One. 2013; 8e81305
- The risk of coronary artery disease and cerebrovascular disease in patients with hepatitis C: a systematic review and meta-analysis.Int. J. Cardiol. 2016; 221: 746-754
- Chronic hepatitis C virus infection increases mortality from hepatic and extrahepatic diseases: a community-based long-term prospective study.J. Infect. Dis. 2012; 206: 469-477
- Increased all-cause, liver, and cardiac mortality among hepatitis C virus-seropositive blood donors.Am. J. Epidemiol. 2008; 167: 743-750
- All-cause, liver-related, and non-liver-related mortality among HCV-infected individuals in the general US population.Clin. Infect. Dis. 2011; 53: 150-157
- GESIDA HIV/HCV Cohort Study Group. Sustained virological response to interferon plus ribavirin reduces non-liver-related mortality in patients coinfected with HIV and Hepatitis C virus.Clin. Infect. Dis. 2012; 55: 728-736
- The effect of sustained virological response on the risk of extrahepatic manifestations of hepatitis C virus infection.Gut. 2018; 67: 553-561
- Hepatitis C virus eradication by direct-acting antiviral agents improves carotid atherosclerosis in patients with severe liver fibrosis.J. Hepatol. 2018; 69: 18-24
- Hepatitis C virus clearance by direct-acting antiviral treatments and impact on insulin resistance in chronic hepatitis C patients.J. Gastroenterol. Hepatol. 2018; 33: 1379-1382
- Direct-acting antiviral therapy for HCV infection is associated with a reduced risk of cardiovascular disease events.Gastroenterology. 2019; 156: 978-996
- Circulation. 2003; 108: 2543-2549
- An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2013; 44: 2064-2089
- Classification and diagnosis of diabetes: standards of medical care in diabetes-2018.Diabetes Care. 2018; 41: S13-S27
- EASL recommendations on treatment of hepatitis C 2018.J. Hepatol. 2018; 69: 461-511
- Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study.Lancet Gastroenterol Hepatol. 2019; 4: 794-804
- Hepatitis C virus and cardiovascular: a review.J. Adv. Res. 2017; 8: 161-168
- Effect of hepatitis C treatment with ombitasvir/paritaprevir/r+ dasabuvir on renal, cardiovascular and metabolic extrahepatic manifestations: a post-hoc analysis of phase 3 clinical trials.Infect. Dis. Ther. 2017; 6: 515-529
- The effect of sustained virological response by direct-acting antivirals on insulin resistance and diabetes mellitus in patients with chronic hepatitis C.Expert Rev. Anti Infect. Ther. 2018; 16: 595-597
- Changes in inflammatory biomarkers in HCV-infected patients undergoing direct acting antiviral-containing regimens with or without interferon.PloS One. 2017; 12e0179400
- Interferon-based therapy reduces risk of stroke in chronic hepatitis C patients: a population-based cohort study in Taiwan.Aliment. Pharmacol. Ther. 2013; 38: 415-423
- Antiviral treatment for hepatitis C virus infection is associated with improved renal and cardiovascular outcomes in diabetic patients.Hepatology. 2014; 59: 1293-1302
- Prospective study of guideline-tailored therapy with direct-acting antivirals for hepatitis C virus-associated mixed cryoglobulinemia.Hepatology. 2016; 64: 1473-1482
- Efficacy and safety of low-dose colchicine after myocardial infarction.N. Engl. J. Med. 2019; 381: 2497-2505
- Residual inflammatory risk associated with interleukin-18 and interleukin-6 after successful interleukin-1β inhibition with canakinumab: further rationale for the development of targeted anti-cytokine therapies for the treatment of atherothrombosis.Eur. Heart J. 2019; Sep 1; (pii: ehz542. [Epub ahead of print])https://doi.org/10.1093/eurheartj/ehz542
- Beneficial effects of vaccination on cardiovascular events: myocardial infarction, stroke, heart failure.Cardiology. 2018; 141: 98-106
Article Info
Publication History
Published online: January 20, 2020
Accepted:
January 15,
2020
Received in revised form:
December 12,
2019
Received:
November 12,
2019
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Non-atherosclerotic cardiac manifestations of chronic hepatitis C virus infection in the era of direct-acting antiviral agentsAtherosclerosisVol. 298
- PreviewAdinolfi and colleagues found that the treatment of hepatitis C virus (HCV) infection by direct-acting antiviral (DAA) agents decreases the incidence of major cardiovascular events [1]. A possible effect of inflammatory cascades for the development of HCV-related atherosclerotic cardiac diseases has been suggested previously [2], and the role of these inflammatory processes on non-atherosclerotic cardiac diseases is also crucial. An impaired cardiac function is reported in HCV-infected patients.
- Full-Text
- Preview
