Risk of Acute Myocardial Infarction Among Hepatitis C Virus (HCV)-Positive and HCV-Negative Men at Various Lipid Levels: Results From ERCHIVES

Abstract

Background: Risk of acute myocardial infarction (AMI) among hepatitis C virus (HCV)-positive versus HCV-negative persons with similar lipid levels is unknown. We determined incident AMI rates among HCV-positive and HCV-negative men among various lipid strata.

Methods: We created a propensity score matched (PSM) cohort and a low cardiovascular disease (CVD) risk cohort. Primary outcome was incident AMI rates by HCV status in each lipid strata using National Cholesterol Program guidelines for lipid strata.

Results: We identified 85863 HCV-positive and HCV-negative men in the PSM population. The incidence rates/1000 patient-years (95% confidence interval [CI]) for AMI among total cholesterol (TC) 200-239 stratum were 5.3 (4.89, 5.71) for HCV-positive versus 4.71 (4.42, 5) for HCV-negative men (P = .02) and for TC >240 mg/dL were 7.38 (6.49, 8.26) versus 6.17 (5.64, 6.71) (P = .02). For low-density lipoprotein cholesterol (LDL) of 130-159 mg/dL, AMI rates were 5.44 (4.97, 5.91) for HCV-positive and 4.81 (4.48, 5.14) for HCV-negative men (P = .03). The rise in risk with increasing lipid levels was greater in younger HCV-positive than in HCV-negative men (e.g., TC > 240 mg/dL: age >50 HR 1.38 [HCV-positive] and 1.12 [HCV-negative]; age ≤50 HR 1.6 [HCV-positive] and 1.29 [HCV-negative]), and more profoundly altered in HCV-positive men by lipid lowering therapy (change in HR with lipid-lowering therapy for TC >240 mg/dL from 1.82 to 1.19 [HCV-positive] from 1.48 to 1.03 [HCV-negative]).

Conclusions: HCV-positive men have a higher risk of AMI than HCV-negative men at higher TC/LDL levels; this risk is more pronounced at a younger age. Lipid lowering therapy significantly reduces this risk, with more profound reduction among HCV-positive versus HCV-negative men at similar lipid levels.

Keywords: ERCHIVES; acute myocardial infarction; cholesterol; hepatitis C virus; lipid.

Figure 1.

Creation of the data set for the current study from ERCHIVES. Abbreviations: BMI, body mass index; COPD, chronic obstructuve pulmonary disease; CVD, cardiovascular disease; CKD, chronic kidney disease; HCV, hepatitis C virus; HIV, human immunodeficiency virus.

Figure 2.

Risk of acute myocardial infarction in the propensity score matched population in various lipid groups (Cox proportional hazards model). Reference categories were total cholesterol < 200, LDL cholesterol < 100, HDL cholesterol <40, and triglycerides < 150 mg/dL. Abbreviations: CI, confidence interval; HCV, hepatitis C virus; HDL, high density lipoprotein cholesterol; HR, hazards ratio; LDL, low density lipoprotein cholesterol.

Figure 3.

Risk of acute myocardial infarction in the low cardiovascular disease risk population in various lipid groups, stratified by age groups (A), BMI (B), and receipt of lipid lowering therapy (C). (Adjusted Cox proportional hazards model, adjusted for age, race, BMI, and receipt of lipid lowering agents, excluding adjustment for outcome of interest in each model). Abbreviations: BMI, body mass index; CI, confidence interval; HCV, hepatitis C virus; HDL, high density lipoprotein cholesterol; HR, hazards ratio; LDL, low density lipoprotein cholesterol.

Figure 3.

Risk of acute myocardial infarction in the low cardiovascular disease risk population in various lipid groups, stratified by age groups (A), BMI (B), and receipt of lipid lowering therapy (C). (Adjusted Cox proportional hazards model, adjusted for age, race, BMI, and receipt of lipid lowering agents, excluding adjustment for outcome of interest in each model). Abbreviations: BMI, body mass index; CI, confidence interval; HCV, hepatitis C virus; HDL, high density lipoprotein cholesterol; HR, hazards ratio; LDL, low density lipoprotein cholesterol.

Figure 3.

Risk of acute myocardial infarction in the low cardiovascular disease risk population in various lipid groups, stratified by age groups (A), BMI (B), and receipt of lipid lowering therapy (C). (Adjusted Cox proportional hazards model, adjusted for age, race, BMI, and receipt of lipid lowering agents, excluding adjustment for outcome of interest in each model). Abbreviations: BMI, body mass index; CI, confidence interval; HCV, hepatitis C virus; HDL, high density lipoprotein cholesterol; HR, hazards ratio; LDL, low density lipoprotein cholesterol.