Wu Qian, He Xiaoxuan, Tong Xiaoning, Li Ying, Dagli-Hernandez Carolina, Honore Patrick M, Wang Xiaoqin
Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
School of Pharmaceutical Sciences, University of São Paulo, São Paulo, SP, Brazil.
Cardiovasc Diagn Ther. 2025 Aug 30;15(4):738-754. doi: 10.21037/cdt-2025-63. Epub 2025 Aug 7.
The association between hepatitis B virus (HBV) infection and cardiovascular disease (CVD) remains uncertain. This study aimed to investigate the impact of HBV infection on 13 major adverse cardiovascular events (MACEs) among patients with CVD with or without statin use.
A prospective cohort study was conducted to examine the cardiovascular, metabolic [atherogenic index (AI) and atherogenic index of plasma (AIP)], hepatic [albumin-bilirubin index (ALBI) score and fibrosis 4 index (FIB-4)] and inflammatory parameters [complete blood count-derived inflammation indices (CBCIIs)] in patients with HBV-cardiovascular comorbidity. In total, 45,013 individuals participated in the baseline survey between June 2020 and August 2023 at The First Affiliated Hospital of Xi'an Jiaotong University. The patients were categorized into two groups according to their surface antigen status. Finally, a sample size of 496 participants was included in the study: patients with coexisting CVD and HBV (n=271) and patients with CVD alone (n=225). In hierarchical analyses, the Breslow-Day test assessed model conformance, while the Mantel-Haenszel test performed stratified Chi-squared testing. To control for potential confounders, logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for MACEs.
HBV infection served as a protective factor of coronary heart disease (CHD) (OR =0.27; 95% CI: 0.12-0.60; P=0.001) and angina pectoris (AP) (OR =0.56; 95% CI: 0.36-0.86; P=0.008). Conversely, HBV infection elevated the risk of acute myocardial infarction (AMI) (OR =2.24, 95% CI: 1.40-3.57; P=0.001). Our study also suggests that statin therapy can lead to a dose-dependent decrease in liver fibrosis, and an increase in the atherogenicity index and systemic inflammatory response among patients with CVD.
Our findings suggest that patients with CVD who also have HBV infection may experience a reduction in MACEs when treated with statins. The observed improvements in hepatic function, atherosclerotic burden, and systemic inflammation associated with statin therapy may contribute to the favorable cardiovascular outcomes among individuals with CVD. This study demonstrates that in CVD patients infected with HBV, concurrent monitoring of metabolic and inflammatory parameters can help reduce the risk of MACEs. Future studies will focus on determining quantitative relationships between individual metabolic or inflammatory indicators and MACEs in larger cohorts.
乙型肝炎病毒（HBV）感染与心血管疾病（CVD）之间的关联仍不确定。本研究旨在调查HBV感染对使用或未使用他汀类药物的CVD患者发生13种主要不良心血管事件（MACE）的影响。
进行了一项前瞻性队列研究，以检查HBV-CVD合并症患者的心血管、代谢[致动脉粥样硬化指数（AI）和血浆致动脉粥样硬化指数（AIP）]、肝脏[白蛋白-胆红素指数（ALBI）评分和纤维化4指数（FIB-4）]以及炎症参数[全血细胞计数衍生的炎症指数（CBCIIs）]。2020年6月至2023年8月期间，共有45,013人参加了西安交通大学第一附属医院的基线调查。根据患者的表面抗原状态将其分为两组。最后，496名参与者纳入研究：CVD合并HBV患者（n = 271）和单纯CVD患者（n = 225）。在分层分析中，Breslow-Day检验评估模型一致性，而Mantel-Haenszel检验进行分层卡方检验。为控制潜在混杂因素，逻辑回归模型估计MACE的比值比（OR）和95%置信区间（CI）。
HBV感染是冠心病（CHD）（OR = 0.27；95%CI：0.12 - 0.60；P = 0.001）和心绞痛（AP）（OR = 0.56；95%CI：0.36 - 0.86；P = 0.008）的保护因素。相反，HBV感染增加了急性心肌梗死（AMI）的风险（OR = 2.24，95%CI：1.40 - 3.57；P = 0.001）。我们的研究还表明，他汀类药物治疗可导致CVD患者肝纤维化呈剂量依赖性降低，致动脉粥样硬化指数和全身炎症反应增加。
我们的研究结果表明，同时患有HBV感染的CVD患者在接受他汀类药物治疗时可能会减少MACE的发生。他汀类药物治疗观察到的肝功能、动脉粥样硬化负担和全身炎症的改善可能有助于CVD患者获得良好的心血管结局。本研究表明，在感染HBV的CVD患者中，同时监测代谢和炎症参数有助于降低MACE的风险。未来的研究将集中于确定更大队列中个体代谢或炎症指标与MACE之间的定量关系。
