HPV increases risk for CVD

J. Brent Muhlestein, MD

This is a confirmatory study of a cross-sectional study that was done about 10 years ago finding the same thing — patients who were positive for high-risk HPV were more likely to have had heart troubles.

In this study, researchers assessed a group of women without previously known heart disease and compared those who were HPV-positive to those who were HPV-negative. The average age was about 33 years. That is an age in which women do not generally get heart disease yet, even if they are at high risk.

The length of follow-up was 5 years. That is not a long follow-up for that young of a population.

There were not a whole lot of events in this population of almost 60,000 people, but there was a statistically greater number of adverse CV events during follow-up among the women who tested high-risk HPV-positive.

My conclusion is that there is a small but definite increase in the risk for future CVD among women who are exposed to high-risk HPV, and the risk is even greater among those high-risk HPV-positive women who also have metabolic syndrome.

There have been discussions regarding whether women should get vaccinated when they are young. The findings in this study probably provide another reason to consider getting the vaccination. Getting the vaccination does not necessarily guarantee that the associated increase in cardiovascular risk will not occur, but it probably will. Certainly, the vaccination has been shown to prevent cervical cancer, and here is another possible reason to do the vaccination.

I do not think there is a specific antiviral drug recommended after a patient has the disease. The major treatment strategy is prevention by vaccination.

Women who have HPV who get heart disease should be treated the same way as you would anybody else who gets heart disease. You might consider starting somebody on a statin sooner if they are HPV-positive, considering it is a risk factor. It is not a huge, powerfully positive risk factor by itself; the HR was about 1.25. It is not as bad as having diabetes or smoking, but it is another risk factor that one might add into one’s thought processes as to whether to begin somebody on statin therapy maybe even sooner than later.

It might be good to do an observational study on vaccinated patients, but it will take a long time. Then it would be useful to do more basic science studies to understand the mechanism. There is a proposed mechanism that pathogenic HPV affects P52, which is a marker that is known to be associated with CAD. If we knew the mechanism better whereby this risk occurs, that might lead us to better directed treatments.

This is further evidence that there is an infectious component associated with CAD. In the past, it has been documented. Intracellular bacteria chlamydia pneumoniae was associated with CAD and is found to grow in atherosclerotic plaque in many cases. Unfortunately, the antibiotic treatment did not work because we did not have an antibiotic that was effective in eradicating chlamydia pneumoniae from the atherosclerotic plaque, although you can treat the chlamydia pneumoniae in the lungs.

Cytomegalovirus was also associated with increased risk for CAD complications.

Infections still may play a role. We need to keep doing research in the whole infectious area to try to find ways to further define it and perhaps find ways to improve our care by understanding these infectious associations.