Impact of hepatitis C virus clearance by direct-acting antiviral treatment on the incidence of major cardiovascular events: A prospective multicentre study
Impact of hepatitis C virus clearance by direct-acting antiviral treatment on the incidence of major cardiovascular events: A prospective multicentre study
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DOI：
10.1016/j.atherosclerosis.2020.01.010
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发表时间：
2020-03-01
期刊：
影响因子：
5.3
通讯作者：
Craxi, Antonio
中科院分区：
文献类型：
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作者：
Adinolfi, Luigi Elio;Petta, Salvatore;Craxi, Antonio
背景和目的：HCV与心血管事件（CV）风险增加相关。直接作用抗病毒药物（DAA）清除HCV是否能降低CV疾病的发生率尚不清楚。我们调查是否HCV根除减少CV events.Methods：在一项前瞻性多中心研究中，2204例HCV患者（F0-F2：29.5%，F3-F4：70.5%）入组。男性占48%，中位年龄为68（59 - 74）岁，BMI为25.9（23.1 - 28）; 24.7%吸烟，18%患有糖尿病，13.2%胆固醇水平> 200 mg/dl，9.1%服用他汀类药物，44%患有高血压。在28（24 - 39）个月的总体中位随访期间，记录了心血管事件，如缺血性心脏病（IHD）和缺血性脑卒中（ICS）。共2204例患者作为对照组进行评价，1668例患者作为病例组进行随访。单因素和多变量analysis.Results：事件CV率每100例患者年治疗前和未治疗的控制和治疗的情况下，分别为1.12，1.14和0.44（p = 0.0001与控制），并观察到相对危险度下降（RR = 0.379; p = 0.0002）。CV风险比对照组低2.0 - 3.5倍（HR 3.671; 95% C.I.：1.871 - 7.201; p <0.001）。计算出的接受治疗以获得患者获益的患者数量为55.26。CV事件的年发生率降低0.68%。HCV清除与CV事件减少独立相关（OR，4.716; 95% CI：1.832 - 12.138; p = 0.001）。结论：通过DAA清除HCV减少了CV事件（IHD和ICS），具有临床和社会经济效益。
Background and aims: HCV is associated with an increased risk of cardiovascular events (CV). Whether HCV clearance by direct-acting antivirals (DAA) reduces incident CV disease is poorly understood. We investigate whether HCV eradication reduces CV events.Methods: In a prospective multicentre study, 2204 HCV patients (F0-F2:29.5%, F3-F4: 70.5%) were enrolled. Males were 48%, median age was 68 (59-74) years and BMI 25.9 (23.1-28); 24.7% were smokers, 18% had diabetes, 13.2% had cholesterol levels > 200 mg/dl and 9.1% took statins, 44% had hypertension. During an overall median follow-up of 28 (24-39) months, incident CV events, such as ischemic heart disease (IHD) and ischemic cerebral stroke (ICS), were recorded. An overall of 2204 patients were evaluated as control group and 1668 patients after HCV elimination were followed as a case group. Factors associated with CV events were evaluated by uni- and multi-variate analyses.Results: Incident CV rates per 100 patient years in pre-treatment and untreated controls and treated cases were 1.12, 1.14 and 0.44 (p = 0.0001 vs. controls), respectively, and a decreased of relative risk (RR = 0.379; p = 0.0002) was observed. CV risk was 2.0-3.5 times lower then in controls (HR 3.671; 95%C.I.:1.871-7.201; p < 0.001). The calculated number of patients to be treated to get a benefit in a patient was 55.26. The annual incidence reduction of CV events was 0.68%. HCV clearance was independently associated with CV events reduction (OR, 4.716; 95% C.I.:1.832-12.138; p = 0.001).Conclusions: HCV clearance by DAA reduces CV events (IHD and ICS) with both clinical and socio-economic benefits.