Global burden of atherosclerotic cardiovascular disease in people with hepatitis C virus infection: a systematic review, meta-analysis, and modelling study

• Type of Material: Article
• Authors: Kuan Ken Lee, University of Edinburgh; Dominik Stelzle, Technical University of Munich; Rong Bing, University of Edinburgh; Mohamed Anwar, University of Edinburgh; Fiona Strachan, University of Edinburgh; Sophia Bashir, University of Edinburgh; David E. Newby, University of Edinburgh; Jasmit S. Shah, Aga Khan University; Michael Chung, Emory University; Gerald S. Bloomfield, Duke University; Chris T. Longenecker, Case Western Reserve University; Shashwatee Bagchi, University of Maryland; Shyamasundaran Kottilil, University of Maryland; Sarah Blach, Center for Disease Analysis Foundation; Homie Razavi, Center for Disease Analysis Foundation; Peter R. Mills, NHS Greater Glasgow & Clyde; Nicholas L. Mills, University of Edinburgh; David A. McAllister, University of Glasgow; Anoop S. Shah, University of Edinburgh
• Language: English
• Date: 2019-10-01
• Publisher: ELSEVIER INC
• Publication Version: Final Published Version
• Copyright Statement: © 2019 The Author(s). Published by Elsevier Ltd.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/S2468-1253(19)30227-4
• Title of Journal or Parent Work: LANCET GASTROENTEROLOGY & HEPATOLOGY
• Volume: 4
• Issue: 10
• Start Page: 794
• End Page: 804
• Grant/Funding Information: This study was supported by the British Heart Foundation through a Clinical Research Training Fellowship (FS/18/25/33454), Intermediate Clinical Research Fellowship (FS/19/17/34172), Senior Clinical Research Fellowship (FS/16/14/32023) and a Research Excellence Award (RE/18/5/34216). DAM is funded by a Wellcome Trust Intermediate Clinical Fellowship (201492/Z/16/Z). DEN is funded by a Senior Investigator Award (WT103782AIA). The Polaris Observatory is supported by the John C Martin Foundation.; British Heart Foundation and Wellcome Trust.
• Keywords: HEART-DISEASE; Gastroenterology & Hepatology; Science & Technology; POPULATION-BASED COHORT; MYOCARDIAL-INFARCTION; HIV; Life Sciences & Biomedicine; INCREASED ALL-CAUSE; ANTIVIRAL TREATMENT; REDUCES RISK; CAUSE-SPECIFIC MORTALITY; TRANSPLANT RECIPIENTS; CORONARY-ARTERY-DISEASE
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Virology

Abstract

Background: More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV. Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without HCV. Two investigators independently reviewed and extracted data from published reports. The main outcome was cardiovascular disease, defined as hospital admission with, or mortality from, acute myocardial infarction or stroke. We calculated the pooled RR of cardiovascular disease associated with HCV using a random-effects model. Additionally, we calculated the population attributable fraction and disability-adjusted life-years (DALYs) from HCV-associated cardiovascular disease at the national, regional, and global level. We also used age-stratified and sex-stratified HCV prevalence estimates and cardiovascular DALYs for 100 countries to estimate country-level burden associated with HCV. This study is registered with PROSPERO, number CRD42018091857. Findings: Our search identified 16 639 records, of which 36 studies were included for analysis, including 341 739 people with HCV. The pooled RR for cardiovascular disease was 1·28 (95% CI 1·18–1·39). Globally, 1·5 million (95% CI 0·9–2·1) DALYs per year were lost due to HCV-associated cardiovascular disease. Low-income and middle-income countries had the highest disease burden with south Asian, eastern European, north African, and Middle Eastern regions accounting for two-thirds of all HCV-associated cardiovascular DALYs. Interpretation: HCV infection is associated with an increased risk of cardiovascular disease. The global burden of cardiovascular disease associated with HCV infection was responsible for 1·5 million DALYs, with the highest burden in low-income and middle-income countries.