Antiviral Treatment for Hepatitis C Is Associated With a Reduced Risk of Atherosclerotic Cardiovascular Outcomes

A Systematic Review and Meta-analysis

Xin Su; Xin Zhao; Jia-Long Deng; Song-Nan Li; Xin Du; Jian-Zeng Dong; Chang-Sheng Ma

Disclosures

J Viral Hepat. 2021;28(4):664-671. 

In This Article

Abstract and Introduction

Abstract

Hepatitis C virus infection (HCV) may be associated with a greater risk of cardiovascular disease (CVD), and the evidence for whether antiviral therapy for HCV could reduce the risk of CVD events is inconsistent. The aim of this meta-analysis was to investigate the association between anti-HCV treatment and the risk of CVD. We searched PubMed, EMBASE and Cochrane Library databases from inception to 20 August 2020. The pooled hazard ratio (HR) with 95% confidence interval (CI) of the risk of CVD events [any CVD, coronary artery disease (CAD) and stroke] was calculated using the random-effects model. A total of eleven studies, including 309,470 subjects, were enrolled in this meta-analysis. Among those, four studies reported on any CVD between anti-HCV–treated and anti-HCV–untreated patients, five studies reported on CAD, and five studies reported on stroke. Also, five studies reported on any CVD between patients with sustained virological response (SVR) and without SVR. Overall, antiviral therapy for HCV was associated with a reduced risk of any CVD (HR = 0.64, 95% CI: 0.50–0.83), CAD (HR = 0.73, 95% CI: 0.55–0.96) and stroke (HR = 0.74, 95% CI: 0.64–0.86). Besides, we found that SVR was associated with a significant decrease in any CVD compared with non-SVR (HR = 0.74, 95% CI: 0.60–0.92). In conclusion, this meta-analysis demonstrated that antiviral therapy for HCV was associated with a reduced risk of CVD events. In addition, the risk of CVD events was lower in individuals with SVR compared with those without SVR.

Introduction

As a global health problem, hepatitis C virus (HCV) infection is a leading cause of chronic liver disease, affecting about 71.1 million people worldwide.[1,2] Meanwhile, HCV infection is associated with a variety of extrahepatic manifestations such as insulin resistance, cryoglobulinemia, glomerulonephritis, coronary artery disease, cerebrovascular disease and myocarditis.[3–5] Recently, increasing data show that HCV infection is associated with a greater risk of atherosclerotic cardiovascular diseases.[6,7]

In recent years, there have been significant advances in antiviral treatment for HCV infection. Interferon (IFN)-based treatment has been widely used as the main anti-HCV therapy for decades, and direct-acting antiviral (DAA) drugs are becoming a new treatment for HCV infection.[1,8] Antiviral therapy for HCV infection is associated with a decreased risk of liver-related complications, and studies have demonstrated that antiviral therapy for HCV reduces a number of extrahepatic events.[9–11] Besides, studies have shown that antiviral therapy for HCV can significantly improve insulin resistance, carotid atherosclerosis and endothelial function.[12–15] However, whether antiviral therapy for HCV could reduce the risk of cardiovascular disease (CVD) events, such as coronary artery disease (CAD) and stroke, is still unclear. Therefore, the aim of this meta-analysis was to investigate whether antiviral therapy for HCV could reduce the risk of CVD.

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