Individuals infected with hepatitis C are at a significantly increased risk of developing heart disease, according to a Lancet analysis that also found hep C-linked CVD is responsible for 1.5 million disability-adjusted life-years (DALYs) annually.
Kuan Ken Lee, MD, of the British Heart Foundation Centre for Cardiovascular Science, and colleagues said in the journal that while an estimated 70 million people worldwide are infected with the hepatitis C virus (HCV), little evidence exists surrounding its relationship with heart disease. And it’s a pressing concern, considering CVD is the world’s most prolific killer and HCV transmission is only expected to rise in low- and middle-income countries (LMICs).
While HCV is certainly present in LMICs, the eastern Mediterranean region and Europe see some of the highest rates of diagnoses (2.3% and 1.5% of the general population, respectively). Prevalence in the U.S. hovers around 1.4%, with 1% of the general population experiencing an active case of hep C.
Lee et al. combed the MEDLINE, Embase, Ovid Global Health and Web of Science databases from inception through May 9, 2018, looking for any longitudinal studies that assessed the risk ratio of CVD in people with HCV compared to those without. Their main outcome was heart disease, defined as hospital admission with or mortality from acute MI or stroke.
Thirty-six studies were included in the team’s analysis, including a total of 341,739 patients with HCV. Typically, patients who contract hepatitis C end up developing a chronic infection, and a little less than a third progress to liver cirrhosis in the following two to three decades.
“Although mortality due to cirrhosis and hepatocellular carcinoma are well-recognized long-term complications of chronic HCV infection, patients with chronic infection are also at increased risk of non-liver-related mortality, including cancer and circulatory death,” the authors wrote, pointing out these patients are often asymptomatic.
Lee and colleagues found patients with HCV were 28% more likely than their healthy peers to develop CVD. They found that globally, 1.5 million DALYs per year were lost due to HCV-associated heart disease.
LMICs bore the highest burden of disease; cases in South Asia, Eastern Europe, North Africa and the Middle East accounted for two-thirds of all HCV-linked cardiovascular DALYs.
The authors estimated more than 90% of the global cardiovascular burden attributable to HCV occurs in LMICs—a number that makes sense considering LMICs bear more than 80% of the global burden of CVD. They said the situation is likely to worsen in coming years due to unsafe healthcare-related injections and increased injection drug use.
“At present, public health programs and access to healthcare services for people with HCV lags behind other comparable infectious diseases, such as HIV or malaria,” Lee and co-authors said. “Considering our study findings, investment in greater strategic integration and linkage of viral hepatitis services with other relevant services, including cardiovascular disease prevention, might be a cost-effective method of facilitating the prevention and management of concurrent major health conditions.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.