Risk of cardiovascular disease due to hepatitis C

Cardiovascular disease risk in patients with hepatitis C infection: Results from two general population health surveys in Canada and the United States (2007-2017). Badawi A*, Di Giuseppe G, Arora P*. PLoS One 2018 Dec 12; 13 (12): e0208839. doi: https://doi.org/10.1371/journal.pone.0208839

This science story highlights collaborative work that explores the link between hepatitis C and cardio-vascular disease in Canada. Research on the impact of infectious disease on chronic disease can be used to help advance human health through applied and discovery research.

What was known about this area prior to your work, and why was the research done?

Hepatitis C virus (HCV) infection is endemic worldwide with an estimated global prevalence of 2.5-3% that causes progressive liver diseases in 170-200 million people. A number of studies have shown that patients with chronic HCV infection may also experience increased rates of cardiovascular diseases (CVD). However, until recently this association was an issue of controversy with some reports demonstrating a higher CVD risk among HCV-infected persons and others not reporting this association. As such, there is no estimate for the CVD risk in Canadians infected with HCV. Our current understanding of how, where and when chronic and infectious diseases converge and interact to impact Canadians is rudimentary. In this study, we evaluated the 10-year risk of CVD in HCV-positive subjects.

What are your most significant findings from this work?

Our study shows a substantial association between HCV infection and an elevated 10-year risk of CVD. We found that HCV-positive patients exhibited an intermediate 10-year CVD risk (10-20%) that was significantly higher than their HCV-negative counterparts who were within the low (<10%) risk range. In Canada, HCV infection was associated with about a 3% increase in the absolute 10-year risk of subclinical and clinical CVD. Several metabolic risk factors were also identified to play a role in the CVD risk resulting from HCV infection. Our findings provide the first estimate of the chronic disease risk in the HCV-infected Canadian subpopulation and provide new knowledge necessary for improving surveillance of HCV patients, and designing strategies for prevention and control of their CVD risk.

What are the implications or impact of the research?

The increased 10-year CVD risk following HCV infection suggests that antiviral therapy should be highly encouraged to minimize the risk of CVD in this population. In addition to its effect on the infectious disease outcome, antiviral therapy may also contribute to a reduced risk and burden of subclinical and clinical CVD risk in HCV infected patients. Our findings represent a milestone in recent efforts to understand the common cause, risk and vulnerabilities interlinking chronic and infectious diseases. Identifying and quantifying chronic complications of infection and evaluating the role of chronic diseases in the development of subsequent infection, we are able to better characterize high-risk groups for priority public health responses and improve public health risk assessment, surveillance, prevention and control.

Additional References of Significance:

  • Khattab MA, Eslam M, Alavian SM. Hepatitis C virus as a multifaceted disease: a simple and updated approach for extrahepatic manifestations of hepatitis C virus infection. Hepat Mon 2010 Fall; 10(4): 258–9.
  • O'Connor SM, Taylor CE, Hughes JM. Emerging infectious determinants of chronic diseases. Emerg Infect Dis 2006 Jul; 12(7):1051–7. doi: https://doi.org/10.3201/eid1207.060037
  • Badawi A*, Velummailum R, Ryoo SG, et al. Prevalence of chronic comorbidities in dengue fever and West Nile virus: A systematic review and meta-analysis. PLoS One 2018 Jul 10; 13(7):e0200200. doi: https://doi.org/10.1371/journal.pone.0200200

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