Impact of Hepatitis C Seropositivity on the Risk of Coronary Heart Disease Events

Naga Venkata Krishna Chand Pothineni,Robert Delongchamp,Srikanth Vallurupalli,Zufeng Ding,Yao Dai,Curt H Hagedorn,Jawahar L Mehta

doi:10.1016/j.amjcard.2014.09.020

Abstract

Chronic infections have been shown to enhance atherogenicity. However, the association between chronic hepatitis C (HCV) and coronary heart disease (CHD) remains controversial. We examined the risk for CHD events in patients with HCV with an emphasis on the risk of CHD events with active infection. We conducted a retrospective cohort study using the Enterprise Data Warehouse at the University of Arkansas for Medical Sciences. HCV positive and negative patients were identified based on serology and incident CHD events were studied. Patient characteristics at entry were compared either by analysis of variance/F-test (continuous variables) or by a Chi-squared test (categorical variables). The joint effect of risk factors for incident CHD was evaluated using logistic regression. A total of 8,251 HCV antibody positive, 1,434 HCV RNA positive and 14,799 HCV negative patients were identified. HCV antibody and RNA positive patients had a higher incidence of hypertension, diabetes mellitus, obesity and chronic lung disease, but lower serum cholesterol levels compared to HCV negative patients (p< 0.001). HCV seropositive patients had a higher incidence of CHD events when compared to controls (4.9% vs. 3.2%, p<0.001). In the HCV cohort, patients with detectable HCV RNA had a significantly higher incidence of CHD events when compared to patients who were only HCV antibody positive with no detectable RNA (5.9% vs. 4.7%, p=0.04). In multivariate logistic regression analysis, both HCV antibody positivity (OR 1.32, 95% CI 1.09-1.60, p<0.001) and HCV RNA positivity (OR 1.59, 95% CI 1.13-2.26, p<0.001) were independent risk factors for incident CHD events. In conclusion, there is increased incidence of CHD events in HCV seropositive patients and the incidence is much higher in patients with detectable HCV RNA when compared to patients with remote infection who are only antibody positive. Lipid profile does not appear to be a good cardiovascular risk stratification tool in HVC patients.

Highlights

A large body of evidence has linked chronic infections with atherosclerotic vascular disease
Mean levels of total cholesterol (T-C), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were significantly lower in the HCV cohort
Previous studies that examined the association of HCV infection and coronary heart disease (CHD) risk have produced conflicting results, which may be due to several limits, including differences in diagnostic criteria, end points used and small sample sizes

Summary

Introduction

A large body of evidence has linked chronic infections with atherosclerotic vascular disease. Chronic infections have been shown to increase the risk of coronary heart disease (CHD) events in humans [2, 3]. An association between chronic hepatitis C (HCV) infection and cardiovascular risk has been supported by some [4,5,6,7,8,9], but not other studies [10,11,12,13]. Some studies have even suggested that HCV infection may be protective against atherosclerosis [13]. A recent systematic review suggested that the association between HCV infection and CHD events is inconclusive and needs additional research [14]. Using a large university based electronic medical records database, we sought to examine the effect of HCV infection on incident CHD events and to study if patients with a detectable HCV RNA have a higher risk of CHD events

Methods

Results

Conclusion