Association between chronic hepatitis C virus infection and myocardial infarction in people living with HIV in the United States

Abstract

Hepatitis C virus (HCV) is common among people living with HIV (PLWH). The potential for extrahepatic manifestations of HCV, including myocardial infarction (MI), is a topic of active research. MI is classified into types, predominantly atheroembolic Type 1 MI (T1MI) and supply-demand mismatch Type 2 MI (T2MI). We examined the association between HCV and MI in the CFAR Network of Integrated Clinical Systems (CNICS), a multi-center clinical cohort of PLWH. MIs were centrally adjudicated and categorized by type using the Universal MI definition. We estimated the association between chronic HCV (RNA+) and time to MI adjusting for demographic characteristics, cardiovascular risk factors, clinical characteristics and substance use. Among 24,755 PLWH aged ≥18, there were 336 T1MI and 330 T2MI during a median of 4.2 years of follow-up. HCV was associated with a 68% greater risk of T2MI (adjusted hazard ratio (aHR) 1.68, 95% CI: 1.22, 2.30) but not T1MI (aHR 0.96, 95% CI: 0.63, 1.45). In a cause-specific analysis of T2MI, HCV was associated with a 2-fold greater risk of T2MI attributed to sepsis (aHR 2.26, 95% CI: 1.34, 3.81). Extrahepatic manifestations of HCV in this high-risk population are an important area for continued research.

Association of hepatitis C infection and acute coronary syndrome

“…Our study also found that some traditional risk factors (diabetes, current smoker) were associated with significantly increased odds of hospitalization for an ACS event in our study population. These findings are consistent with the literature [5][6][7][8]10] , suggesting that our study population is sufficiently valid to detect relevant associations between ACS and CVD factors. The literature has mixed findings regarding the association between BMI and CVD, and our study found that BMI was not associated with odds of hospitalization for ACS.…”

“…[6] Finally, a recent study found that chronic HCV infection was associated with increased supply-demand mismatch type 2 AMI but not classical atheroembolic type 1 AMI, highlighting the importance of distinguishing between types of MI. [10] Our study found that infection with HCV was not associated with the odds of hospitalization for an ACS event compared to hospitalization for other conditions. This finding did not support the hypothesis that HCV infection is associated with ACS events among hospitalized patients and was consistent with some studies that showed similar results.…”

“…In addition, Younossi et al found that chronic HCV infection was independently associated with congestive heart failure but not ischemic heart disease or stroke, and there was no association with cardiovascular disease (CVD) in almost 20,000 persons in the NHANES [6] . Finally, a recent study found that chronic HCV infection was associated with increased supply-demand mismatch type 2 AMI but not classical atheroembolic type 1 AMI, highlighting the importance of distinguishing between types of MI [10] . Our study found that infection with HCV was not associated with the odds of hospitalization for an ACS event compared to hospitalization for other conditions.…”

Features of myocardial infarction with ST segment elevation in patients with non-alcoholic liver steatosis and steatohepatitis

“…Данные о роли других заболеваний печени, прежде всего хронического вирусного гепатита В и С, в развитии коронарного атеросклероза и ОКС неоднозначны. Некоторые авторы не выявили повышенного риска развития ИМ у пациентов с HCV-инфекцией [32,33], однако в другом исследовании HCV-инфекция сопровождалась значительным увеличением риска ИМ 2 типа (скорректированное отношение рисков 1,46, 95% ДИ 1,09-1,97), но не ИМ 1 типа [34]. По данным анализа 686 HCV-позитивных пациентов, вирусная инфекция оказалась независимым предиктором ангиографически подтвержденного поражения коронарных артерий (скорректированное ОШ 4,2; 95% ДИ 1,4-13,0) [35].…”