Direct-Acting Antiviral Therapy for HCV Infection Is Associated With a Reduced Risk of Cardiovascular Disease Events

Abstract

is associated with an increased risk of cardiovascular disease (CVD) events. It is not clear whether treatment with directacting antiviral (DAA) agents affects risk of CVD. METHODS:We searched the Electronically Retrieved Cohort of HCV-Infected Veterans database for patients with chronic HCV infection (n ¼ 242,680) and identified patients who had been treated with a pegylated interferon and ribavirin regimen (n ¼ 4436) or a DAA-containing regimen (n ¼ 12,667). Treated patients were matched for age, race, sex, and baseline values with patients who had never received treatment for HCV infection (controls). All subjects were free of any CVD event diagnosis of HCV infection at baseline. The primary outcome was incident CVD events, identified by International Classification of Diseases, Ninth Edition, Clinical Modification or International Classification of Diseases, Tenth Edition code, in the different groups and in patients with vs without a sustained virologic response to therapy. RESULTS: There were 1239 (7.2%) incident CVD events in the treated groups and 2361 (13.8%) events in the control group. Incidence rates were 30.9 per 1000 patient-years (95% CI 29.6-32.1) in the control group and 20.3 per 1000 patientyears (95% CI 19.2-21.5) in the treated groups (P < .0001). Treatment with pegylated interferon and ribavirin (hazard ratio 0.78; 95% CI 0.71-0.85) or a DAA regimen (hazard ratio 0.57; 95% CI 0.51-0.65) was associated with a significantly lower risk of a CVD event compared with no treatment (controls). Incidence rates for CVD events were 23.5 per 1000 patient-years (95% CI 21.8-25.3) in the group treated with the pegylated interferon and ribavirin regimen, 16.3 per 1000 patient-years (95% CI 14.7-18.0) in the group treated with a DAA regimen, and 30.4 (95% CI 29.2-31.7) in the control group. A sustained virologic response was associated with a lower risk of incident CVD events (hazard ratio 0.87; 95% CI 0.77-0.98). CONCLUSIONS: In an analysis of a cohort of HCV-infected veterans, treatment of HCV infection was associated with a significant decrease in risk of CVD events. Patients treated with a DAA regimen and patients who achieved sustained virologic responses had the lowest risk for CVD events.

Improvement of hyperuricemia in chronic hepatitis C patients receiving directly acting antiviral agents

“…45,46 The beneficial effect of a reduction in the risk of cardiovascular events has been observed to be limited in patients with severe fibrosis. 43 Coincidently, we observed that the SUA decrements were also less evident in cases of severe fibrosis. The role of SUA as a trigger or bystander, in terms of cardiovascular events in CHC patients, awaits future clarification.…”

“…This raises the issue as to whether SUA decrements reduce the risk of cardiovascular events and all‐cause mortality, which requires further exploration and discussion . The beneficial effect of a reduction in the risk of cardiovascular events has been observed to be limited in patients with severe fibrosis . Coincidently, we observed that the SUA decrements were also less evident in cases of severe fibrosis.…”

“…Uric acid has been traditionally considered to represent oxidative stress, and hyperuricemia has been associated with cardiovascular disease . Moreover, HCV eradication may improve extrahepatic manifestations, including cardiovascular events . This raises the issue as to whether SUA decrements reduce the risk of cardiovascular events and all‐cause mortality, which requires further exploration and discussion .…”

“…15,[40][41][42] Moreover, HCV eradication may improve extrahepatic manifestations, including cardiovascular events. 43,44 This raises the issue as to whether SUA decrements reduce the risk of cardiovascular events and all-cause mortality, which requires further exploration and discussion. 45,46 The beneficial effect of a reduction in the risk of cardiovascular events has been observed to be limited in patients with severe fibrosis.…”

Systematic review: chronic viral hepatitis and metabolic derangement

“…A recent retrospective, a case‐controlled study involved 4436 pegylated interferon/ribavirin‐treated and 12 667 DAA‐treated CHC patients. Treatment with pegylated interferon and ribavirin (hazard ratio, 0.78; 95% CI, 0.71‐0.85) or a DAA regimen (0.57; 95% CI, 0.51‐0.65) was associated with a significantly lower risk of a cardiovascular event than that associated with no treatment . However, findings regarding vascular parameters following SVR that is achieved by DAA are inconsistent.…”