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

Abstract

Background: An association of Coronary artery disease (CAD) with hepatitis C (HCV) has been suggested, but definitive data are still lacking. Aim: Our study sought to estimate the prevalence and severity of CAD in HCV patients compared to with age-, sex-, and race-matched controls without HCV infection. Subjects and methods: 63 HCV-infected patients were compared with 63 age, race, and sex-matched controls without HCV infection undergoing coronary angiography for evaluation of CAD. CAD was defined as more than a 50% blockage in any of the proximal coronary arteries on angiogram. The severity of the stenosis was defined by the modified Reardon severity scoring system: <50% stenosis of the luminal diameter, 1 point; 50-74%, 2 points; 75-99%, 3 points; 100% or total obstruction, 4 points. The points for each lesion in the proximal coronary circulation were summed to give the score for severity. Results: A significantly higher prevalence of CAD was noted in the HCV population (69.8% vs. 47.6%, = 0.01). The combined Reardon's severity score in the HCV group was significantly higher compared to the controls (6.26 ± 5.39 vs. 2.6 ± 3.03, P < 0.0005). Additionally, significant multivessel CAD (>50% stenosis and $2 vessels involved) was also noted significantly more commonly in the HCV group compared to controls (57.1% vs. 15.9%, P < 0.0005). Conclusion: In this retrospective study the prevalence and severity of CAD was higher in HCV patients who were evaluated for CAD by angiogram compared with matched non-HCV patients. HCV-positive status is potentially a risk factor for CAD. ( J CLIN EXP HEPATOL 2013;3: 186-191)

Eradication of hepatitis C virus and non‐liver‐related non–acquired immune deficiency syndrome–related events in human immunodeficiency virus/hepatitis C virus coinfection

“…(39,40) The association between HCV infection and cardiovascular events is a contentious issue. Several observational studies have found that in the general population, HCV is an independent factor associated with coronary artery disease, (41)(42)(43)(44)(45) stroke, (39,46,47) and peripheral artery disease. (48) HCV infection has also been found to increase the likelihood of cardiovascular disease among HIV-infected individuals.…”

Extrahepatic comorbidities associated with hepatitis C virus in HIV-infected patients

“…In another study carried out among patients included in the Veterans Aging Cohort Study-Virtual Cohort (VACS-VC), HIV-infected women had increased rates and risk of incident cardiovascular disease events, as compared to uninfected women, after adjustment for demographics, Framingham risk factors, other comorbidities, and substance use and abuse [39 && ]. Several observational studies in the last 2 years have found that HCV infection is an independent factor associated with coronary artery disease events including a study from the VACS-VC [40], HCV infection was also found to be independently associated with an increased hazard of acute myocardial infarction in a case-control study from a clinical center in New York [41], a retrospective cohort from the University of Arkansas [42], and two cross-sectional studies performed in Taiwan [43] and Denmark [44]. However, in a systematic review of casecontrol and cohort studies published from 1995 to 2013, the association between chronic HCV infection and coronary artery disease was concluded to remain unclear [45].…”

Risk of Cardiovascular Disease Due to Chronic Hepatitis C Infection: A Review

“…Alyan et al 11 used a modified Reardon severity scoring system and demonstrated that CAD severity scores were significantly higher in the HCV seropositive group than in the control group ( p < 0.001), and HCV seropositivity was an independent predictor for the severity of coronary atherosclerosis (OR: 2.018, 95% CI: 1.575–2.579; p < 0.001) after adjustment for age, sex, smoking, hypertension, DM, body mass index (BMI), CRP and fibrinogen. 11 In patients undergoing coronary angiography for evaluation of CAD, Satapathy et al 63 observed a significantly higher prevalence of CAD (69.8% vs. 47.6%, p = 0.01), significantly higher modified Reardon’s severity scores (6.26 ± 5.39 vs. 2.6 ± 3.03, p < 0.0005), and significant multivessel CAD (defined as >50% stenosis in ≥2 vessels involved; 57.1% vs. 15.9%, p < 0.0005) among the HCV-infected patients compared to controls. Salam et al 64 reported that HCV antibody-positive patients had more severe coronary lesions than seronegative patients among those referred for angiography.…”