Chronic HBV infection linked to increased risk for intracerebral hemorrhage
Click Here to Manage Email Alerts
Chronic hepatitis B virus infection was significantly associated with an increased risk for intracerebral hemorrhage but not other types of stroke in Chinese adults, according to data presented at the EASL Congress.
“China has the greatest burden of hepatitis B in the world,” Elizabeth Hamilton, a DPhil candidate in the Nuffield Department of Population Health at the University of Oxford, said. “One in three people with chronic hepatitis B reside in China and it’s estimated that about 10 million people living with chronic hepatitis B in China today will die by the year 2030, mostly from avoidable liver cancers.”
She continued: “We see a higher total incidence of stroke and a higher proportion of intracerebral hemorrhage in China compared to other countries and, interestingly, despite ischemic stroke having about a fourfold higher incidence compared to intracerebral hemorrhage, intracerebral hemorrhage accounts for an equal number of stroke deaths.”
To investigate the role of chronic HBV in stroke etiology, Hamilton and colleagues used data from the prospective China Kadoorie Biobank to identify 500,991 adults (mean age, 52.1 years; 41% men) from 10 geographically diverse regions, all of whom underwent hepatitis B surface antigen measurement at baseline. Overall, 3% were HBsAg-positive.
During an average follow-up of 11 years, researchers reported 59,117 total stroke events, of which 11,318 were intracerebral hemorrhage (ICH), 49,971 were ischemic stroke (IS), 3,036 were unspecified stroke and 995 were subarachnoid hemorrhage (SAH).
Results showed HBsAg-positivity was associated with an increased risk for ICH (adjusted HR = 1.29; 95% CI, 1.16-1.44), both fatal (aHR = 1.36; 95% CI, 1.16-1.6) and nonfatal (aHR = 1.23; 95% CI, 1.06-1.44). There was no significant association between HBsAg-positivity and the risk for IS (aHR = 0.97; 95% CI, 0.91-1.03), SAH (aHR = 0.87; 95% CI, 0.57-1.33) or other/unspecified stroke (aHR = 1.12; 95% CI, 0.89-1.42).
Researchers also measured metabolic and blood biochemistry values of HBsAg-positive and HBsAg-negative individuals and reported that those who were HBsAg-positive had lower levels of total cholesterol (1.43 mmol/L vs. 1.61 mmol/L), LDL cholesterol (2.19 mmol/L vs. 2.32 mmol/L), triglycerides (1.43 mmol/L vs. 1.61 mmol/L) and albumin (41.4 g/L vs. 42.1 g/L), and higher levels of alanine transaminase (22.82 u/L vs. 18.65 u/L) and aspartate transaminase (30.35 u/L vs. 26.2 u/L).
“Chronic hepatitis B virus may be a risk factor for intracerebral hemorrhage but not for ischemic stroke,” Hamilton concluded. “In terms of mechanisms that may explain this association, if it’s real, this could be due to altered liver function with altered coagulation status or related pathways. ... In terms of next steps, we need more prospective evidence around this question.”
Collapse
Hamilton E, et al. Abstract OS-093-YI: Chronic hepatitis B virus infection and risk of stroke types: a prospective cohort study of 0.5 million Chinese adults. Presented at: EASL Congress; June 21-24, 2023; Vienna (hybrid meeting).
Click Here to Manage Email Alerts