Patients with a hepatitis C virus (HCV) infection have an increased risk for cardiovascular disease (CVD), with the highest burden placed on low-income and middle-income countries. This is according to a study in the Lancet Gastroenterology & Hepatology.
Researchers from the United States and Europe performed a meta-analysis of 36 longitudinal studies (n=341,739) that assessed the risk for CVD in patients with HCV vs patients without HCV. The primary outcome of the analysis was CVD, which was defined as hospital admission with, or mortality from, acute myocardial infarction or stroke.
The researchers also examined the population attributable fraction and disability-adjusted life-years (DALYs) from CVD associated with HCV infection. Patients from a total of 100 countries were included in age-stratified and sex-stratified HCV prevalence estimates and CVD DALYs to assess the geographic burden of HCV and CVD.
Patients with HCV had a significantly higher risk for CVD compared with patients without HCV (pooled risk ratio [RR], 1.28; 95% CI, 1.18-1.39). By outcome, the RR was 1.13 (95% CI, 1.00-1.28) for acute myocardial infarction, 1.38 (95% CI, 1.19-1.60) for stroke, and 1.39 (95% CI, 1.24-1.55) for cardiovascular mortality. An infection with HCV coupled with HIV was associated with a higher risk for CVD compared with HIV monoinfection (RR, 1.20; 95% CI, 1.09-1.32).
Approximately 1.5 million (95% CI, 0.9-2.1) DALYs were attributed to CVD associated with HCV infection. Low-income and middle-income countries had the highest burden of HCV-associated CVD vs high-income countries (1.4 million [95% CI, 0.88-1.95] DALYs vs 0.1 million [95% CI, 0.07-0.12] DALYs, respectively).
Limitations of the meta-analysis were the inclusion of data from mostly high-income countries and the significant heterogeneity in the RR estimates.
The researchers concluded that the study “findings are of public health importance and could inform future research and healthcare policies to improve risk stratification and treatment strategies aimed at reducing the combined global burden of HCV and extrahepatic sequelae such as CVD.”
Disclosure: Several of the study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Lee KK, Stelzle D, Bing R, et al. Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study [published online July 31, 2019]. Lancet Gastroenterol Hepatol. doi:10.1016/S2468-1253(19)30227-4