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Treatment for HCV Regardless of SVR Lowers Risk for CVD Events

Treatment with either pegylated interferon with ribavirin or direct-acting antivirals for hepatitis C correlated with a significantly lower risk for cardiovascular disease, especially among patients who achieved sustained virologic response, according to a study published in Gastroenterology.

“We found that untreated HCV infected persons had nearly twice the rate of incident CVD events compared with those who initiated treatment. This was observed for [coronary artery disease (CAD)] events ... as well as for stroke and peripheral vascular disease,” Adeel A. Butt, MD, from the Veterans Affairs Pittsburgh Healthcare System, and colleagues wrote. “Our study adds significant new information by assessing older pegylated interferon/ribavirin and newer DAA regimens and their effect on CVD outcomes.”

The study comprised 4,436 patients with chronic hepatitis C who received treatment with pegylated interferon (PEG-IFN) and ribavirin and 12,667 patients who received DAAs. The study also included an equal number of matched controls with HCV who never received any treatment for their infection.

Incident CVD events were significantly more likely to occur among the untreated controls compared with the overall treatment group (13.8% vs. 7.2%; P < .001). This difference remained significant when compared with those who received PEG-IFN and ribavirin and those who received DAAs (P < .001).

Among the treatment group, achieving SVR correlated with a lower incidence rate (OR = 19.1; 95% CI, 17.7-20.4) compared with those who did not achieve SVR (OR = 22.5; 95% CI, 20.5-24.5).

Multivariate analysis showed that black race (HR = 1.09; 95% CI, 1.01-1.19) and Fibrosis-4 index scores higher than 3.25 (HR = 1.46; 95% CI, 1.31-1.62) correlated with a higher risk for incidence CVD events.

Treatment with DAAs had the lowest risk for CVD events (HR = 0.57; 95% CI, 0.51-0.65) compared with no treatment and treatment with PEG-IFN and ribavirin. Achieving SVR correlated with the overall lowest risk (HR = 0.87; 0.77-0.98).

“Taken together, these observations strengthen the mounting evidence of the association between advanced liver fibrosis and CVD events, and a significant reduction in such risk with treatment,” Butt and colleagues wrote. “With cure rates of [more than] 90% with DAAs and a clear survival benefit with treatment, more HCV infected persons will live longer. Reducing CVD risk will be increasingly important in these patients.” – by Talitha Bennett

Disclosure: Butt reports he received grant support from Gilead and Merck. Please see the full study for the other authors’ relevant financial disclosures.