Antiviral Treatment for Hepatitis C Is Associated With a Reduced Risk of Atherosclerotic Cardiovascular Outcomes

A Systematic Review and Meta-analysis

Xin Su; Xin Zhao; Jia-Long Deng; Song-Nan Li; Xin Du; Jian-Zeng Dong; Chang-Sheng Ma


J Viral Hepat. 2021;28(4):664-671. 

In This Article

Materials and Methods

Search Strategy

Two independent researchers searched EMBASE, PubMed and Cochrane Library databases from inception to 20 August 2020. The following keyword terms were used in the search strategy: "Hepatitis C", "antiviral agents", "cardiovascular disease", "coronary artery disease", "stroke", and "cerebrovascular disease". No language limitation was applied.

Study Selection

The studies meeting the following criteria were enrolled in the meta-analysis: studies were cohort, case-control or randomized controlled studies; participants in the study were divided into the anti-HCV treatment group and non-anti-HCV therapy group or sustained virological response (SVR) group and non-SVR group; studies had results of CVD events (any CVD, CAD and stroke); and studies had hazard ratio (HR) values and corresponding 95% confidence interval (CI). Articles were excluded if the data were not available.

Data Abstraction

The process of data abstraction was performed by two independent investigators in a standardized manner. The information extracted from each study was as follows: first author name, the title of the study, year of publication, regions, number of subjects, study design, the proportion of men, mean age, antiviral therapy regimen and outcomes. The quality of studies enrolled in this meta-analysis was evaluated by the Newcastle-Ottawa Scale (NOS).

Statistical Analysis

We estimated pooled HRs with 95% CIs using the DerSimonian and Laird random-effects model,[16] and the association between antiviral therapy for HCV and the risk of CVD events was quantified by HR values. We used Cochran's test and I2 statistics to examine heterogeneity.[17] To explore possible explanations for heterogeneity, we conducted meta-regression analysis. Because of the small number of published studies, a formal statistical analysis of funnel plot asymmetry for assessment of publication bias was not used. All the statistical analyses were analysed by Stata software (version 15.0; Stata Corporation, College Station, TX). A p value <.05 was considered statistically significant.