Hepatitis C Virus Infection and the Risk of Coronary Disease

Clinical Infectious Diseases  15 July 2009  V.49  N.2  p.225–232

Adeel A. Butt,1,2,3 Wang Xiaoqiang,2,3 Matthew Budoff,5 David Leaf,6,7 Lewis H. Kuller,4 and Amy C. Justice8,9

1University of Pittsburgh School of Medicine, 2Center for Health Equity Research and Promotion, 3VA Pittsburgh Healthcare System, and 4Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania; 5Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 6VA Greater Los Angeles Healthcare System, and 7David Geffen School of Medicine at UCLA, Los Angeles, California; and 8VA Connecticut Healthcare System, West Haven, and 9Yale University School of Medicine and Public Health, New Haven, Connecticut

Background. The association between hepatitis C virus (HCV) infection and coronary artery disease (CAD) is controversial. We conducted this study to determine and quantify this association.

Methods. We used an established, national, observational cohort of all HCV-infected veterans receiving care at all Veterans Affairs facilities, the Electronically Retrieved Cohort of HCV Infected Veterans, to identify HCV-infected subjects and HCV-uninfected control subjects. We used the Cox proportional-hazards model to determine the risk of CAD among HCV-infected subjects and control subjects.

Results. We identified 82,083 HCV-infected and 89,582 HCV-uninfected subjects. HCV-infected subjects were less likely to have hypertension, hyperlipidemia, and diabetes but were more likely to abuse alcohol and drugs and to have renal failure and anemia. HCV-infected subjects had lower mean (± standard deviation) total plasma cholesterol (175 ± 40.8 mg/dL vs. 198 ± 41.0 mg/dL), low-density lipoprotein cholesterol (102 ± 36.8 mg/dL vs. 119 ± 38.2 mg/dL), and triglyceride (144 ± 119 mg/dL vs. 179 ± 151 mg/dL) levels, compared with HCV-uninfected subjects ( for all comparisons). In multivariable analysis, HCV infection was associated with a higher risk of CAD (hazard ratio, 1.25; 95% confidence interval, 1.20–1.30). Traditional risk factors (age, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia) were associated with a higher risk of CAD in both groups, whereas minority race and female sex were associated with a lower risk of CAD.

Conclusions. HCV-infected persons are younger and have lower lipid levels and a lower prevalence of hypertension. Despite a favorable risk profile, HCV infection is associated with a higher risk of CAD after adjustment for traditional risk factors.

abstract

http://www.journals.uchicago.edu/doi/abs/10.1086/599371