Impact of Hepatitis C Virus Clearance on Cardiovascular Risk: A Real-World Experience From the Nationwide Taiwan Hepatitis C Virus Registry

Abstract

Hepatitis C virus (HCV) infection is associated with an increased risk of cardiovascular disease (CVD); however, the impact of interferon (IFN)-based therapy on cardiovascular outcomes remains unclear. This nationwide cohort study included 7411 patients with HCV from The Taiwanese Chronic Hepatitis C Cohort registry who received IFN-based therapy between 2003 and 2014. Patients were categorized into sustained virological response (SVR) (n = 5785) and non-SVR (n = 1676) groups. The incidence of new-onset CVD events, including stroke, coronary artery disease, heart failure, and arrhythmia, was assessed using three Cox proportional hazard models adjusted for different sets of confounding factors. The cumulative CVD incidence was comparable in the SVR and non-SVR groups (11.2% vs. 10.2%, p = 0.609). SVR was not significantly associated with a reduced overall CVD risk among the three models [hazards ratio (HR) = 0.88, 95% confidence interval (CI): 0.71-1.05, p = 0.158]. However, a lower risk of stroke was observed in patients who achieved an SVR, although the difference was not significant (HR = 0.84, 95% CI: 0.74-0.94). The results of the sensitivity analyses confirmed these findings. An SVR following IFN-based therapy did not substantially reduce the overall CVD risk; however, a potential reduction in stroke risk was observed. These results emphasize the importance of long-term cardiovascular risk assessments and highlight the need for further research, particularly in the direct-acting antiviral era in which increased cardiovascular benefits may be expected.

Keywords: cardiovascular disease; hepatitis C; interferon therapy; stroke; sustained virologic response.

FIGURE 1

The flow chart of this study. All CVDs including stroke, peripheral arterial occlusive disease, heart failure, arrhythmia, cerebrovascular accident, and coronary artery disease. CVD, cardiovascular disease; HBV, hepatitis B virus; HCV, hepatitis C virus; HIV, human immunodeficiency virus; IFN, interferon; SVR, sustained virologic response.

FIGURE 2

Cumulative incidence of new‐onset cardiovascular disease (CVD) between sustained virologic response (SVR) and non‐SVR patients after chronic hepatitis C (CHC) patients who achieved antiviral therapy, considering death as a competing risk. (a) All CVDs, (b) stroke, (c) peripheral arterial occlusive disease, (d) heart failure, (e) arrhythmia, (f) cerebrovascular accident, (g) coronary artery disease.