Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study

Abstract

Background More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without HCV. Two investigators independently reviewed and extracted data from published reports. The main outcome was cardiovascular disease, defined as hospital admission with, or mortality from, acute myocardial infarction or stroke. We calculated the pooled RR of cardiovascular disease associated with HCV using a random-effects model. Additionally, we calculated the population attributable fraction and disability-adjusted life-years (DALYs) from HCVassociated cardiovascular disease at the national, regional, and global level. We also used age-stratified and sexstratified HCV prevalence estimates and cardiovascular DALYs for 100 countries to estimate country-level burden associated with HCV. This study is registered with PROSPERO, number CRD42018091857. Findings Our search identified 16 639 records, of which 36 studies were included for analysis, including 341 739 people with HCV. The pooled RR for cardiovascular disease was 1•28 (95% CI 1•18-1•39). Globally, 1•5 million (95% CI 0•9-2•1) DALYs per year were lost due to HCV-associated cardiovascular disease. Low-income and middleincome countries had the highest disease burden with south Asian, eastern European, north African, and Middle Eastern regions accounting for two-thirds of all HCV-associated cardiovascular DALYs. Interpretation HCV infection is associated with an increased risk of cardiovascular disease. The global burden of cardiovascular disease associated with HCV infection was responsible for 1•5 million DALYs, with the highest burden in low-income and middle-income countries.

Impact of hepatitis C virus clearance by direct-acting antiviral treatment on the incidence of major cardiovascular events: A prospective multicentre study

“…In conclusion, data from this study show that HCV clearance significantly reduces the risk of major CV events. Our finding has a great clinical impact since in 2015 it was estimated that around 71 million people worldwide are still infected, and it has been evaluated that 1.5 million (95% CI 0.9-2.1) disability-adjusted life-years (DALY) from cardiovascular diseases are to be attributed to chronic HCV infection [26]. Therefore, HCV clearance has advantages both in prognostic and clinical terms and has a significant impact on public health with savings on healthcare costs.…”

“…Chronic HCV infection is associated with an increased risk of atherosclerotic cardiovascular diseases [26]. There is a wide literature supporting that HCV infection increases the subclinical and clinical risk of CV diseases [2][3][4][5][6][7][8][9][10][11] through multiple direct and indirect proatherogenic immune and inflammatory mechanisms, metabolic alterations (insulin resistance, diabetes) and a direct cardiovascular tropism of HCV [27].…”

Time‐dependent incidence and risk for myocardial infarction in patients with alcoholic cirrhosis

“…Therefore, we cannot tell whether nonalcoholic cirrhosis or alcoholism is associated with MI in the same temporal way. Concerning other aetiologies, cumulated evidence suggests that chronic hepatitis C is associated with MI, in support of a relationship between liver disease and MI.…”

Inflammatory and cardiovascular diseases biomarkers in chronic hepatitis C virus infection: A review

“…4 Chronic viral diseases, in particular human immunodeficiency virus (HIV), have been strongly linked to the development of clinical cardiac diseases. 5,6 Chronic HCV infection (CHC) has been linked to subclinical and clinical cardiovascular diseases (CVD), such as myocardial infarctions, congestive heart failure, cerebrovascular accident (CVA), and peripheral arterial disease, 7 and proposed mechanisms include chronic inflammation and immune activation driven by HCV infection as well as direct endothelial invasion and dysfunction. Studies have shown increased prevalence of certain cardiac biomarkers associated with increased CVD risk in patients with CHC compared to age-matched uninfected patients.…”