Hepatitis C virus infection and the risk of coronary disease.
Hepatitis C virus infection and the risk of coronary disease.
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DOI：
10.1086/599371
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发表时间：
2009-07-15
期刊：
影响因子：
--
通讯作者：
Justice AC
中科院分区：
文献类型：
--
作者：
Butt AA;Xiaoqiang W;Budoff M;Leaf D;Kuller LH;Justice AC
丙型肝炎病毒（HCV）感染与冠状动脉疾病（CAD）之间的关系存在争议。我们进行了这项研究，以确定和量化这种关联。我们使用了一个已建立的，全国性的，观察性队列的所有HCV感染的退伍军人接受护理在所有退伍军人事务部的设施，电子检索队列的HCV感染的退伍军人，以确定HCV感染的主题和HCV未感染的对照主题。我们使用考克斯比例风险模型来确定HCV感染受试者和对照受试者中CAD的风险。我们确定了82，083名HCV感染者和89，582名HCV未感染者。HCV感染者不太可能有高血压、高脂血症和糖尿病，但更可能滥用酒精和药物，并有肾衰竭和贫血。与未感染HCV的受试者相比，HCV感染受试者的平均（±标准差）血浆总胆固醇（175 ± 40.8 mg/dL vs. 198 ± 41.0 mg/dL）、低密度脂蛋白胆固醇（102 ± 36.8 mg/dL vs. 119 ± 38.2 mg/dL）和甘油三酯（144 ± 119 mg/dL vs. 179 ± 151 mg/dL）水平较低。在多变量分析中，HCV感染与CAD的高风险相关（风险比，1.25; 95%置信区间，1.20-1.30;所有比较P <0.001）。传统的危险因素（年龄、高血压、慢性阻塞性肺疾病、糖尿病和高脂血症）与两组中较高的CAD风险相关，而少数民族和女性与较低的CAD风险相关。HCV感染者较年轻，血脂水平较低，高血压发病率较低。尽管有良好的风险特征，但在调整传统风险因素后，HCV感染与CAD的风险较高相关。
The association between hepatitis C virus (HCV) infection and coronary artery disease (CAD) is controversial. We conducted this study to determine and quantify this association. We used an established, national, observational cohort of all HCV-infected veterans receiving care at all Veterans Affairs facilities, the Electronically Retrieved Cohort of HCV Infected Veterans, to identify HCV-infected subjects and HCV-uninfected control subjects. We used the Cox proportional-hazards model to determine the risk of CAD among HCV-infected subjects and control subjects. We identified 82,083 HCV-infected and 89,582 HCV-uninfected subjects. HCV-infected subjects were less likely to have hypertension, hyperlipidemia, and diabetes but were more likely to abuse alcohol and drugs and to have renal failure and anemia. HCV-infected subjects had lower mean (± standard deviation) total plasma cholesterol (175 ± 40.8 mg/dL vs. 198 ± 41.0 mg/dL), low-density lipoprotein cholesterol (102 ± 36.8 mg/dL vs. 119 ± 38.2 mg/dL), and triglyceride (144 ± 119 mg/dL vs. 179 ± 151 mg/dL) levels, compared with HCV-uninfected subjects. In multivariable analysis, HCV infection was associated with a higher risk of CAD (hazard ratio, 1.25; 95% confidence interval, 1.20–1.30; P < .001 for all comparisons). Traditional risk factors (age, hypertension, chronic obstructive pulmonary disease, diabetes, and hyperlipidemia) were associated with a higher risk of CAD in both groups, whereas minority race and female sex were associated with a lower risk of CAD. HCV-infected persons are younger and have lower lipid levels and a lower prevalence of hypertension. Despite a favorable risk profile, HCV infection is associated with a higher risk of CAD after adjustment for traditional risk factors.
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