AT THE INTERNATIONAL LIVER CONGRESS 2015
VIENNA (FRONTLINE MEDICAL NEWS) – Major cardiovascular (CV) events are significantly increased in hospital patients who are infected with the hepatitis C virus (HCV) versus those who are not, according to data presented at the meeting sponsored by the European Association for the Study of the Liver.
A retrospective analysis of more than 200,000 inpatients with and without HCV infection at discharge showed that those with HCV were 29% more likely to have had an acute MI, 98% more likely to have had a cerebral vascular accident (CVA), and 88% times more likely to have coronary artery disease (CAD). There was also an 8% increased risk for heart failure (HF).
“HCV infection is strongly linked to an increase in cardiovascular outcome, length of hospital stay, and cost of care,” Dr. Firew Wubiee and Dr. Charles Howell of Howard University, Washington, D.C., reported in an ePoster at the meeting.
For their retrospective analysis, data were obtained from the 2011 Nationwide Inpatient Sample, which is a large all-payer inpatient care database in the United States that contains information on more than 7 million hospital stays.
ICD-9 codes were used to identify all inpatient cases with and without HCV infection at discharge and those with major CV events, excluding those with liver cirrhosis, hepatocellular carcinoma, and cases of liver transplantation. Dr. Wubiee and Dr. Howell found that inpatients with HCV infection were significantly (P < .001) younger than were those without HCV (mean age 52.8 vs. 57.9 years). They were significantly more likely (P < .001) to be male (62.2% vs. 40%), have a smoking history (45.5% vs. 22.7%), be from ethnic or racial minorities (26.4% vs. 5.1%), and have a household income of less than $39,000 (41% vs. 29.1%).
While inpatients with HCV were also significantly (P < .001) more likely than were those without HCV to have diabetes mellitus (2.1% vs. 1.8%), they were significantly less likely (P < .001) to have other known CV risk factors such as obesity (8.7% vs. 11.8%), dyslipidemia (13.2% vs. 28.1%), and hypertension (49.7% vs. 51%).
Odds ratios for CV outcomes were adjusted for multiple confounding factors, including age, race, obesity, diabetes, dyslipidemia, smoking, alcohol use, hypertension, and hepatitis B infection. The adjusted odds ratios for major CV outcomes were 2.29 for AMI, 1.98 for CVA, 1.88 for CAD, and 1.08 for HF (all P < .001).
The duration of in-hospital treatment was longer for patients with HCV than for those without, with adjusted differences of 1.3 days for AMI (P < .001), 2.02 days for CVA (P < .003), 0.52 days for CAD (P < .001), and 0.37 days for HF (P < .001).
The adjusted cost of inpatient care was also higher for HCV-infected versus noninfected individuals with a mean cost difference of $10,126 for AMI, (P < .001), $10,105 for CVA (P < .002), $2,703 for CAD (P < .001), and $1,895 for HF (P < .001).
“We hypothesized that the inflammation and insulin resistance related to HCV increases the prevalence of cardiovascular diseases compared to patients without HCV,” Dr. Wubiee and Dr. Howell observed.
“The results are consistent with mounting evidence for [a] biological and epidemiological association between HCV infection and cardiovascular morbidity,” they said and suggested “HCV needs to be considered a cardiovascular risk factor.”