Hepatitis C treatment linked to reduced CVD risk

Last Updated: 2018-12-27

By Lorraine L. Janeczko

NEW YORK (Reuters Health) - Treating hepatitis C virus (HCV) is associated with a significantly reduced risk of cardiovascular disease (CVD) events, according to a new study.

Infection with HCV is known to be linked with a higher risk of CVD events, Dr. Adeel A. Butt of the U.S. Department of Veterans Affairs VA Pittsburgh Healthcare System, in Pennsylvania, and colleagues write in Gastroenterology, online November 13.

"Newer all-oral therapies have dramatically changed the treatment paradigm for hepatitis C virus infection. With these therapies, over 90% of treated patients can now be cured," Dr. Butt told Reuters Health by email.

"However, the benefits of treatment go beyond the clearance and eradication of the virus," he added. "The reduction in risk of CVD events with newer all-oral therapy was greater than that seen with older interferon-based therapy and was greater in patients who achieved a virologic cure."

Dr. Butt and colleagues searched the Electronically Retrieved Cohort of HCV-infected Veterans (ERCHIVES) database and found more than 242,000 patients with chronic HCV infection. The primary outcome was incident CVD events in participants with or without a sustained virologic response (SVR) to therapy.

The research team identified 4,436 patients who had been treated with pegylated interferon and ribavirin and 12,667 who had been treated with a direct-acting antiviral (DAA).

Patients were matched for age, sex, race, and baseline values with controls who had never been treated for HCV infection. At baseline, all patients were free of any CVD event diagnosis or HCV infection.

The authors excluded patients diagnosed with any CVD event at baseline, those with human immunodeficiency virus (HIV) or hepatitis B virus (HBV) coinfection, and those missing HCV RNA data, which was used to determine SVR rates.

Overall, 1,239 (7.2%) incident CVD events were recorded in the treated group vs. 2,361 (13.8%) in the control group. The incidence rate was 20.3/1,000 patient-years in the treated groups vs. 30.9/1,000 patient-years in the control group (P<0.0001).

On multivariable analysis, treatment with pegylated interferon and ribavirin (hazard ratio, 0.78) or DAA (HR, 0.57) was linked with a signfiicantly lower risk of suffering a CVD event.

Adjusted incidence rates for CVD events per 1,000 patient-years were 23.5 in the group treated with pegylated interferon and ribavirin, 16.3 the DAA group and 30.4 in the control group (P<0.0001).

SVR was linked with lower risk of incident CVD events compared to no SVR (HR, 0.87; P=0.03).

Dr. Luis A. Marcos, an associate professor of clinical medicine at the Renaissance School Medicine at Stony Brook University in New York State, told Reuters Health by email, "This is an important study. What is new from the study is that the reduction of cardiovascular events is even better when the treatment is based on direct-acting antivirals (new treatments) than on older drugs (interferon-based regimens), so now we know that treatment choice is important."

"With the new drugs available nowadays with cure rates above 90%, patients with HCV infection may reduce their heart attacks and other cardiovascular complications," added Dr. Marcos, who was not involved in the study.

Gilead Sciences and Merck, which sell HCV medications, funded the study. Dr. Butt reported ties to the companies.

SOURCE: https://bit.ly/2EHnyq7

Gastroenterology 2018.