Higher Prevalence and More Severe Coronary Artery Disease in HCV Infected Patients: A Case Control Study: ACG/AstraZeneca Fellow Award

Abstract

Purpose: Coronary artery disease (CAD) continues to be the most common cause of morbidity and mortality worldwide. An association of CAD with hepatitis C has been suggested, but definitive data are still lacking. Our study is aimed to estimate the prevalence and severity of CAD in hepatitis C patients and to compare it with age, sex and race matched controls without hepatitis C virus infection. Methods: Sixty-three of 934 hepatitis C patients had coronary angiography for evaluation of CAD seen between May 2002 and December 2008 at our center was included in the study. An age, race and sex matched controls (1:1 ratio) were than obtained from 6017 patients who had cardiac angiography for evaluation of CAD seen between October 2008 to September 2010. Patients with known HCV infections were excluded from the controls. Coronary artery disease was defined as more than 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: No significant differences were noted in the prevalence of DM, hypertension, hyperlipidemia, and family history of CAD, alcohol abuse, tobacco dependence, IVDU and HIV infections in the HCV infected populations compared to the controls. However, a significantly higher level of serum triglyceride levels and serum alanine amino transferases was noted in the HCV populations. A significantly higher prevalence of coronary artery disease was noted in the HCV population compared to the controls (69.8% vs 47.6%, P= 0.01). More severe stenosis was noted in the HCV populations in majority of the most commonly affected coronary arteries (Table 1). Multivariate logistic regression analysis revealed age (P=0.03, OR =1.04, 95% CI 1.00-1.08), tobacco dependence (P=0.007, OR 3.26, 95% CI 1.39-7.63) and HCV positive status (P=0.007, OR 3.12, 95% CI 1.37-7.10) were significant factors that predicted coronary artery disease.Table 1: Prevalence and severity of coronary artery diseaseConclusion: Hepatitis C virus infected patients have significantly higher prevalence and severity of coronary artery disease in symptomatic patients undergoing coronary angiogram. HCV positive status is potentially a risk factor for coronary artery disease.