Hepatitis C Raises Risk of Cardiovascular Disease

By Liz Highleyman

In a study described in the July 15, 2009 issue of Clinical Infectious Diseases.[http://www.journals.uchicago.edu/doi/abs/10.1086/599371], Adeel Butt from the University of Pittsburgh School of Medicine and colleagues evaluated the association between HCV infection and coronary artery disease.

The analysis compared 82,083 HCV-infected patients and 89,582 HCV-uninfected patients receiving care at all Veterans Affairs facilities, identified using the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES).

Results

HCV-infected participants were significantly less likely than HCV negative participants to have hypertension (high blood pressure; 42% vs. 50) and diabetes (21% vs 22%).

HCV positive patients were less likely to have hyperlipidemia (39% vs 72%) and had lower average blood fat levels:

o Total plasma cholesterol: 175 vs 198 mg/dL;
o Low-density lipoprotein (LDL or "bad") cholesterol: 102 vs 119 mg/dL;
o Triglycerides: 144 vs 179 mg/dL.

Conversely, HCV positive patients were more likely be heavy alcohol users (39% vs 19%) and/or drug users (31% vs 12%)

Patients with HCV were also more likely to have serious liver disease (78% vs 29%), anemia (10% vs 11%), and kidney failure (3% vs 1%).

In a multivariate analysis controlling for potentially confounding factors, HCV infection was associated with about a 25% higher risk of coronary artery disease.

Traditional risk factors (e.g., age, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia) were associated with a higher risk of coronary artery disease in both groups.

"Minority" (non-white) race and female sex, however, were associated with a lower risk of coronary artery disease.

"HCV-infected persons are younger and have lower lipid levels and a lower prevalence of hypertension," the study authors concluded. "Despite a favorable risk profile, HCV infection is associated with a higher risk of coronary artery disease after adjustment for traditional risk factors."

The researchers suggested that the elevated cardiovascular risk may be due to increased inflammation, immune activation, and blood clotting in people with HCV - similar to the growing body of evidence regarding ongoing HIV infections.

VA Pittsburgh Healthcare System, University of Pittsburgh School of Medicine, University of Pittsburgh Graduate School of Public Health, and Center for Health Equity Research and Promotion, Pittsburgh, PA; Los Angeles Biomedical Research Institute at Harbor?UCLA Medical Center, VA Greater Los Angeles Healthcare System, and David Geffen School of Medicine at UCLA, Los Angeles, CA; VA Connecticut Healthcare System, West Haven, and Yale University School of Medicine and Public Health, New Haven, CT.

7/10/09

Reference

AA Butt, W Xiaoqiang, M Budoff, and others. Hepatitis C virus infection and the risk of coronary disease. Clinical Infectious Diseases 49(2): 225-232. July 15, 2009.