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

Disclosures

J Viral Hepat. 2021;28(4):664-671. 

In This Article

Results

We retrieved 1,576 articles from EMBASE, PubMed and Cochrane library, of which 176 were duplicates. 1,400 articles were excluded according to the title or abstract. After full-text review, 110 articles were excluded, four of which were excluded because of duplicated studies by the same researchers from the same population.[18–21] Finally, 11 studies with usable data were included in the meta-analysis[22–32] (Figure 1).

Figure 1.

The process of study selection for the meta-analysis

Study Characteristics

The main characteristics of the included studies are shown in Table 1. A total of 309,470 subjects were included in the meta-analysis. All included studies were cohort studies. Of the eleven studies, four studies were conducted in America, two in Taiwan, two in France, two in Italy and one in the United Kingdom.

Antiviral Therapy for HCV and Risk of any CVD

Four studies reported the outcome of any CVD between anti-HCV–treated and anti-HCV–untreated patients. The analysis using a random-effects model showed that antiviral therapy for HCV was associated with a significant reduction in any CVD (HR = 0.64, 95% CI: 0.50–0.83) (Figure 2).

Figure 2.

Forest plot showing the association between antiviral therapy (AVT) for HCV and the long-term risk of any cardiovascular disease

Antiviral Therapy for HCV and Risk of CAD

Five studies reported the outcome of CAD between anti-HCV–treated and anti-HCV–untreated patients. In the overall analysis, we found that antiviral therapy for HCV was related to an obvious decrease in CAD (HR = 0.73, 95% CI: 0.55–0.96) (Figure 3). Moderate heterogeneity was noted (I2 = 65.0%, p = .022). Meta-regression models showed that regions (p = .792), mean age (p = .334), therapy regimen (p = .110) and the publication year (p = .616) did not contribute to the generation of heterogeneity.

Figure 3.

Forest plot showing the association between antiviral therapy (AVT) for HCV and the long-term risk of coronary artery disease

Antiviral Therapy for HCV and Risk of Stroke

Five studies reported the outcome of stroke between anti-HCV–treated and anti-HCV–untreated patients. The analysis showed that antiviral treatment was related to an apparent reduction in stroke (HR = 0.74, 95% CI: 0.64–0.86) (Figure 4).

Figure 4.

Forest plot showing the association between antiviral therapy (AVT) for HCV and the long-term risk of stroke

SVR and Risk of any CVD

Five studies demonstrated the outcome of any CVD between patients with SVR and without SVR. In the overall analysis, we found that SVR was associated with a significant decrease in any CVD (HR = 0.74, 95% CI: 0.60–0.92) (Figure 5).

Figure 5.

Forest plot showing the long-term risk of any cardiovascular disease between patients with sustained virological response (SVR) and patients without SVR

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