British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Department of Neurology, Center for Global Health, Technical University of Munich, Munich, Germany.
Lancet Gastroenterol Hepatol. 2019 Oct;4(10):794-804. doi: 10.1016/S2468-1253(19)30227-4. Epub 2019 Jul 31.
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.
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.
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.
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.
British Heart Foundation and Wellcome Trust.
据估计，全球有超过 7000 万人感染丙型肝炎病毒（HCV）。新出现的证据表明，HCV 与动脉粥样硬化性心血管疾病之间存在关联。我们旨在确定 HCV 与心血管疾病之间的关联，并估计归因于 HCV 的心血管疾病的国家、区域和全球负担。
在本次系统评价和荟萃分析中，我们在 2018 年 5 月 9 日之前，在 MEDLINE、Embase、Ovid Global Health 和 Web of Science 数据库中，不限制语言，检索了评估 HCV 患者与无 HCV 患者心血管疾病风险比（RR）的纵向研究。两名调查人员独立审查并提取了已发表报告中的数据。主要结局是心血管疾病，定义为急性心肌梗死或中风住院或死亡。我们使用随机效应模型计算与 HCV 相关的心血管疾病的汇总 RR。此外，我们计算了在国家、区域和全球层面归因于 HCV 相关心血管疾病的人群归因分数和残疾调整生命年（DALY）。我们还使用了 100 个国家的年龄分层和性别分层 HCV 流行率估计值和心血管 DALY，以估计与 HCV 相关的国家层面负担。本研究在 PROSPERO 注册，编号 CRD42018091857。
我们的搜索共确定了 16639 条记录，其中 36 项研究被纳入分析，共纳入 341739 名 HCV 患者。心血管疾病的汇总 RR 为 1.28（95%CI 1.18-1.39）。全球每年因 HCV 相关心血管疾病而损失的 DALY 为 150 万（95%CI 0.9-2.1）。低收入和中等收入国家的疾病负担最高，南亚、东欧、北非和中东地区占所有 HCV 相关心血管 DALY 的三分之二。
HCV 感染与心血管疾病风险增加相关。与 HCV 感染相关的心血管疾病的全球负担导致 150 万 DALY 丧失，其中低收入和中等收入国家的负担最重。
英国心脏基金会和惠康信托基金会。
