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. 2017 Oct;24(10):814-822.
doi: 10.1111/jvh.12705. Epub 2017 Apr 10.

Performance of the Pooled Cohort atherosclerotic cardiovascular disease risk score in hepatitis C virus-infected persons

K W Chew  1 , D Bhattacharya  1 , T B Horwich  1 , P Yan  2   3 , K A McGinnis  2 , C Tseng  1 , M S Freiberg  4   5 , J S Currier  1 , A A Butt  2   6   7   8   9
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Performance of the Pooled Cohort atherosclerotic cardiovascular disease risk score in hepatitis C virus-infected persons

K W Chew et al. J Viral Hepat. 2017 Oct.

Abstract

Chronic hepatitis C virus (HCV) infection has been associated with an increased risk for cardiovascular disease (CVD). The recommended Pooled Cohort atherosclerotic cardiovascular disease (ASCVD) risk equation for estimation of 10-year CVD risk has not been validated in HCV-infected populations. We examined the performance of the ASCVD risk score in HCV-infected persons, using the national Electronically Retrieved Cohort of HCV Infected Veterans to derive a cohort of HCV-infected and uninfected subjects without baseline ASCVD, hepatitis B, or HIV infection, and with low-density lipoprotein cholesterol level<190 mg/dL. Performance of the ASCVD risk equation was assessed by Cox proportional hazard regression, C-statistics and Hosmer-Lemeshow statistic. The cohort included 70 490 HCV-infected and 97 766 HCV-uninfected men with mean age of 55 years, 56% White and 29% Black. Incident CVD event rates were similar between the two groups (13.2 and 13.4 events/1000 person-years), with a higher incidence of coronary heart disease events in the HCV-uninfected group and of stroke events in the HCV-infected group. Adjusting for ASCVD risk score, HCV infection was associated with higher risk for an ASCVD event in the subgroup with baseline ASCVD risk ≥7.5% (HR: 1.19, P<.0001). C-statistics were poor in both the HCV-infected and uninfected groups (0.60 and 0.61, respectively). By Hosmer-Lemeshow test, the ASCVD risk equation overestimated risk amongst lower risk patients and underestimated risk amongst higher risk patients in both the HCV-infected and uninfected groups. Further investigation is needed to determine whether a modified equation to accurately predict ASCVD risk in HCV-infected persons is warranted.

Keywords: atherosclerotic cardiovascular disease score; cardiovascular disease; cardiovascular risk assessment; hepatitis C virus.

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Conflict of interest statement

Statement of Interests

Authors’ declaration of personal interests: K.W.C. has received research support (to the institution) from Merck and Gilead. D.B. has received grant support (to the institution) from Merck, AbbVie and Bristol-Myers Squibb. J.S.C. has received grant support (to the institution) from Theratechnologies. A.A.B. has received grant support (to the institution) from Merck, AbbVie and Gilead. All other authors report no conflicts of interest.

Declaration of Funding Interests: This study was supported by a seed grant from the UCLA AIDS Institute/Center for AIDS Research (National Institute of Allergy and Infectious Diseases at the National Institutes of Health P30AI028697). This material is the result of work supported with resources and the use of facilities at the VA Pittsburgh Healthcare System and the central data repositories maintained by the VA Information Resource Center, including the National Patient Care Database, Decisions Support System Database and Pharmacy Benefits Management Database. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Figures

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Figure 1
Derivation of cohort
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