Risk of Acute Myocardial Infarction Among Hepatitis C Virus (HCV)-Positive and HCV-Negative Men at Various Lipid Levels: Results From ERCHIVES

被引:26
作者
Butt, Adeel A. [1 ,2 ,3 ,4 ]
Yan, Peng [1 ]
Chew, Kara W. [5 ]
Currier, Judith [5 ]
Corey, Kathleen [6 ,7 ]
Chung, Raymond T. [6 ,7 ]
Shuaib, Ashfaq [2 ]
Abou-Samra, Abdul-Badi [2 ]
Butler, Javed [8 ]
Freiberg, Matthew S. [9 ]
机构
[1] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA
[2] Hamad Med Corp, Hamad Healthcare Qual Inst, Doha, Qatar
[3] Weill Cornell Med Coll, Doha, Qatar
[4] Weill Cornell Med Coll, New York, NY USA
[5] Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA
[6] Massachusetts Gen Hosp, Boston, MA 02114 USA
[7] Harvard Med Sch, Boston, MA 02114 USA
[8] SUNY Stony Brook, Stony Brook, NY 11794 USA
[9] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA
基金
美国国家卫生研究院;
关键词
hepatitis C virus; acute myocardial infarction; lipid; cholesterol; ERCHIVES; CORONARY-ARTERY-DISEASE; CARDIOVASCULAR RISK; INFECTED PATIENTS; HEART-DISEASE; HIV; PROGRESSION; THERAPY;
D O I
10.1093/cid/cix359
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
071005 [微生物学]; 100108 [医学免疫学];
摘要
Background. Risk of acute myocardial infarction (AMI) among hepatitis C virus (HCV)-positive versus HCV-negative persons with similar lipid levels is unknown. We determined incident AMI rates among HCV-positive and HCV-negative men among various lipid strata. Methods. We created a propensity score matched (PSM) cohort and a low cardiovascular disease (CVD) risk cohort. Primary outcome was incident AMI rates by HCV status in each lipid strata using National Cholesterol Program guidelines for lipid strata. Results. We identified 85 863 HCV-positive and HCV-negative men in the PSM population. The incidence rates/1000 patient-years (95% confidence interval [CI]) for AMI among total cholesterol (TC) 200-239 stratum were 5.3 (4.89, 5.71) for HCV-positive versus 4.71 (4.42, 5) for HCV-negative men (P = .02) and for TC >240 mg/dL were 7.38 (6.49, 8.26) versus 6.17 (5.64, 6.71) (P = .02). For low-density lipoprotein cholesterol (LDL) of 130-159 mg/dL, AMI rates were 5.44 (4.97, 5.91) for HCV-positive and 4.81 (4.48, 5.14) for HCV-negative men (P = .03). The rise in risk with increasing lipid levels was greater in younger HCV-positive than in HCV-negative men (e.g., TC > 240 mg/dL: age > 50 HR 1.38 [HCV-positive] and 1.12 [HCV-negative]; age = 50 HR 1.6 [HCV-positive] and 1.29 [HCV-negative]), and more profoundly altered in HCV-positive men by lipid lowering therapy (change in HR with lipid-lowering therapy for TC > 240 mg/dL from 1.82 to 1.19 [HCV-positive] from 1.48 to 1.03 [HCV-negative]). Conclusions. HCV-positive men have a higher risk of AMI than HCV-negative men at higher TC/LDL levels; this risk is more pronounced at a younger age. Lipid lowering therapy significantly reduces this risk, with more profound reduction among HCV-positive versus HCV-negative men at similar lipid levels.
引用
收藏
页码:557 / 565
页数:9
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