VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania; Weill Cornell Medical College, New York, New York and Doha, Qatar; Hamad Medical Corporation, Doha, Qatar.
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Gastroenterology. 2019 Mar;156(4):987-996.e8. doi: 10.1053/j.gastro.2018.11.022. Epub 2018 Nov 13.
BACKGROUND & AIMS: Infection with hepatitis virus C (HCV) is associated with an increased risk of cardiovascular disease (CVD) events. It is not clear whether treatment with direct-acting antiviral (DAA) agents affects risk of CVD.
We searched the Electronically Retrieved Cohort of HCV-Infected Veterans database for patients with chronic HCV infection (n = 242,680) and identified patients who had been treated with a pegylated interferon and ribavirin regimen (n = 4436) or a DAA-containing regimen (n = 12,667). Treated patients were matched for age, race, sex, and baseline values with patients who had never received treatment for HCV infection (controls). All subjects were free of any CVD event diagnosis of HCV infection at baseline. The primary outcome was incident CVD events, identified by International Classification of Diseases, Ninth Edition, Clinical Modification or International Classification of Diseases, Tenth Edition code, in the different groups and in patients with vs without a sustained virologic response to therapy.
There were 1239 (7.2%) incident CVD events in the treated groups and 2361 (13.8%) events in the control group. Incidence rates were 30.9 per 1000 patient-years (95% CI 29.6-32.1) in the control group and 20.3 per 1000 patient-years (95% CI 19.2-21.5) in the treated groups (P < .0001). Treatment with pegylated interferon and ribavirin (hazard ratio 0.78; 95% CI 0.71-0.85) or a DAA regimen (hazard ratio 0.57; 95% CI 0.51-0.65) was associated with a significantly lower risk of a CVD event compared with no treatment (controls). Incidence rates for CVD events were 23.5 per 1000 patient-years (95% CI 21.8-25.3) in the group treated with the pegylated interferon and ribavirin regimen, 16.3 per 1000 patient-years (95% CI 14.7-18.0) in the group treated with a DAA regimen, and 30.4 (95% CI 29.2-31.7) in the control group. A sustained virologic response was associated with a lower risk of incident CVD events (hazard ratio 0.87; 95% CI 0.77-0.98).
In an analysis of a cohort of HCV-infected veterans, treatment of HCV infection was associated with a significant decrease in risk of CVD events. Patients treated with a DAA regimen and patients who achieved sustained virologic responses had the lowest risk for CVD events.
丙型肝炎病毒（HCV）感染与心血管疾病（CVD）事件风险增加有关。目前尚不清楚直接作用抗病毒（DAA）药物治疗是否会影响 CVD 风险。
我们在电子检索的 HCV 感染退伍军人队列数据库中搜索了患有慢性 HCV 感染的患者（n=242680），并确定了接受聚乙二醇干扰素和利巴韦林治疗方案（n=4436）或包含 DAA 的治疗方案（n=12667）的患者。接受治疗的患者与从未接受 HCV 感染治疗的患者（对照组）在年龄、种族、性别和基线值方面进行匹配。所有患者在基线时均无任何 CVD 事件或 HCV 感染的诊断。主要结局是不同组中发生的 CVD 事件，以及在治疗后有持续病毒学应答的患者与无持续病毒学应答的患者中发生的 CVD 事件，通过国际疾病分类，第九版，临床修正或国际疾病分类，第十版代码来确定。
在治疗组中发生了 1239 例（7.2%）的 CVD 事件，在对照组中发生了 2361 例（13.8%）的事件。对照组的发病率为每 1000 患者年 30.9 例（95%CI 29.6-32.1），治疗组的发病率为每 1000 患者年 20.3 例（95%CI 19.2-21.5）（P<.0001）。与未治疗组相比，接受聚乙二醇干扰素和利巴韦林治疗（危险比 0.78；95%CI 0.71-0.85）或 DAA 方案治疗（危险比 0.57；95%CI 0.51-0.65）与 CVD 事件风险显著降低相关。接受聚乙二醇干扰素和利巴韦林治疗的患者的 CVD 事件发病率为每 1000 患者年 23.5 例（95%CI 21.8-25.3），接受 DAA 方案治疗的患者为每 1000 患者年 16.3 例（95%CI 14.7-18.0），对照组为每 1000 患者年 30.4 例（95%CI 29.2-31.7）。持续病毒学应答与 CVD 事件的发生风险降低相关（危险比 0.87；95%CI 0.77-0.98）。
在对 HCV 感染退伍军人队列的分析中，HCV 感染的治疗与 CVD 事件风险的显著降低相关。接受 DAA 方案治疗的患者和获得持续病毒学应答的患者发生 CVD 事件的风险最低。
