Hepatitis C Virus Infection and the Risk of Coronary Disease

Abstract

Background The association between hepatitis C virus (HCV) infection and coronary artery disease (CAD) is controversial. We conducted this study to determine and quantify this association. Methods We used an established, national, observational cohort of all HCV-infected veterans receiving care at all Veterans Affairs facilities, the Electronically Retrieved Cohort of HCV Infected Veterans, to identify HCV-infected subjects and HCV-uninfected control subjects. We used the Cox proportional-hazards model to determine the risk of CAD among HCV-infected subjects and control subjects. Results We identified 82,083 HCV-infected and 89,582 HCV-uninfected subjects. HCV-infected subjects were less likely to have hypertension, hyperlipidemia, and diabetes but were more likely to abuse alcohol and drugs and to have renal failure and anemia. HCV-infected subjects had lower mean (± standard deviation) total plasma cholesterol (175 ± 40.8 mg/dL vs. 198 ± 41.0 mg/dL), low-density lipoprotein cholesterol (102 ± 36.8 mg/dL vs. 119 ± 38.2 mg/dL), and triglyceride (144 ± 119 mg/dL vs. 179 ± 151 mg/dL) levels, compared with HCV-uninfected subjects. In multivariable analysis, HCV infection was associated with a higher risk of CAD (hazard ratio, 1.25; 95% confidence interval, 1.20–1.30; P < .001 for all comparisons). Traditional risk factors (age, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia) were associated with a higher risk of CAD in both groups, whereas minority race and female sex were associated with a lower risk of CAD. Conclusions HCV-infected persons are younger and have lower lipid levels and a lower prevalence of hypertension. Despite a favorable risk profile, HCV infection is associated with a higher risk of CAD after adjustment for traditional risk factors.

Higher Prevalence and More Severe Coronary Artery Disease in Hepatitis C Virus-infected Patients: A Case Control Study

“…The study further confirmed earlier reported results of more severe CAD in HCV-infected patients based on a visual scoring system adapted from Reardon et al 2,13 A large retrospective controlled study using the national Veterans Administration database found a significant association of HCV infection with CAD after adjusting for multiple traditional risk factors. 3 Similar associations were reported in another earlier reported study. 1 In the current study we were able to show that HCV-seropositive status is a strong predictor for CAD in addition to other traditional factors such as age, DM, tobacco dependence and family history of CAD.…”

“…[1][2][3] Reports of a negative association between HCV infection and CAD have further compounded any meaningful inferences. [4][5][6] Reports of an increased risk [1][2][3] or an increase in measures of subclinical atherosclerosis have fueled continued interest to further explore any such associations. [7][8][9] One of the major drawbacks of the earlier negative studies was the lack of well-designed controls and failure to control for the risk factors associated with CAD.…”

Associations of chronic hepatitis C with metabolic and cardiac outcomes

“…12 In addition to metabolic conditions (DM and IR), HCV has also been associated with arthrosclerosis and coronary artery disease. [13][14][15] Although HCV and its contribution to DM and IR can explain some of these associations, the exact underlying mechanism of how CH-C can predispose to cardiovascular complications remains unknown. The aim of this study was to assess the independent association of HCV with metabolic conditions (DM, IR, hypertension and hyperlipdaemia) as well as cardiovascular complications using a large population-representative sample.…”

Hepatitis C Virus Infection, Lipids, and Coronary Heart Disease: A Pandora's Box

“…For instance, several studies found patients with chronic hepatitis C to have significantly lower cholesterol levels than those with chronic hepatitis B infection, suggesting that the alteration in lipids observed in hepatitis C infection is virus-specific. [2][3][4] Further, when stratifying by pretreatment levels of alanine aminotransferase or hepatitis C RNA, we found no difference in rebound levels of cholesterol or LDL, suggesting that the degree of hepatic inflammation or level of viremia does not influence cholesterol or LDL levels. We are not aware of any studies evaluating the change in serum LDL and cholesterol levels following viral suppression during hepatitis B therapy, but agree that such evaluation would allow this question to be definitely answered.…”

“…4 Furthermore, HCV infection may independently predict an increased severity of CHD based on Reardon severity score in a population of individuals with angiographically determined CHD. 5 In this article, the authors demonstrated the association between HCV infection and relative hypolipidemia in several contexts.…”