High-risk human papillomavirus (HPV) infection may be associated with the risk for cardiovascular disease (CVD) in Korean women, according to a study published in Circulation Research.
CVD is the leading global cause of death, accounting for more than 17.3 million deaths in 2013, and the number is expected to continue to rise. Although there have been many advances in management strategies to lessen conventional CVD risk factors, it remains the leading cause of death. The most common sexually transmitted infection worldwide is HPV, and certain oncogenic strains have been established as causative agents of anogenital cancers in women. Recent evidence has shown an association between oncogenic strains of HPV and increased prevalence of the self-reported diagnosis of myocardial infarction and stroke in women in the Unites States. It has been hypothesized that HPV infections may contribute to CVD, however, no cohort studies have evaluated the relationship between high-risk HPV infection and new-onset CVD. Therefore, this cohort study investigated the association between high-risk HPV infection and the development of CVD.
From 2011 to 2016, 63,411 women aged 30 years or older without CVD at baseline who underwent a high-risk HPV test, were followed either annually or biennially. High-risk HPV tests were performed as a cervical cancer screening. Presence of CVD was obtained through the linkage to the Health Insurance and Review Agency database. The primary end point of this study was the development of CVD. The cumulative incidence of CVD by high-risk HPV positivity was assessed using Kaplan-Meier plots. Whether the associations between high-risk HPV and CVD differ with the presence of obesity was also examined, as metabolic syndrome and/or obesity has been associated with increased risk for HPV infection or persistence of the infection. To analyze this, a stratified analysis by the presence of obesity (defined as a body mass index ≥25 kg/m2 according to Asian-specific criteria) was performed. Additional subgroup analyses were also stratified.
Results showed that high-risk HPV infection was significantly associated with incident CVD. The prevalence of high-risk HPV infection was 7.6%. During 261,598.9 person-years of follow-up, a total of 1122 cases of new-onset CVD were identified. This association was stronger in women with obesity and metabolic syndrome. Multivariable-adjusted hazard ratio for incident CVD comparing women with high-risk who were HPV positive with women who were high-risk but HPV negative, was 1.13 (95% CI, 0.90-1.43) in nonobese women and 1.71 (95% CI, 1.17-2.50) in obese women. Further, the hazard ratio for incident CVD in high-risk women who were HPV positive compared with high-risk women who were HPV negative was 1.09 (95% CI, 0.87-1.36) in women who did not have metabolic syndrome vs 1.99 (95% CI,1.28-3.08) in women with metabolic syndrome. Although results suggested an association between high-risk HPV and incident CVD in women, the exact mechanisms underlying the association between oncogenic HPV infection and the risk for CVD are not fully understood.
Overall, the study authors concluded that, “Further studies are required to identify the specific high-risk HPV genotypes that may contribute to CVD and implement vaccine strategies as a modifiable risk factor for the reduction of CVD in addition to prevention of anogenital cancers.”
Joo EJ, Chang Y, Kwon MJ, Cho A, Cheong HS, Ryu S. High-risk human papillomavirus infection and the risk of cardiovascular disease in Korean women: a cohort study. Circ Res. 2019;124(5):747-756.