HCV: DAA therapy best lowers CVD risk

  • Butt AA & al.
  • Gastroenterology
  • 13 Nov 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • HCV treatment, particularly with direct-acting antivirals (DAAs), is tied to a significantly reduced risk for cardiovascular disease (CVD) events.

Why this matters

  • HCV raises CVD risk, but the effect of DAAs was not previously evaluated.

Study design

  • 242,680 patients in an HCV-infected veterans database; 5.2% (n=12,667) received DAAs and 1.8% (n=4436) received pegylated interferon+ribavirin (PR).
  • Treated patients were matched with nontreated controls by age, race, sex, and atherosclerotic (AS) CVD (ASCVD) score.
  • Funding: Gilead Sciences.    

Key results

  • Incident CVD event rate was lower among treated patients than controls (7.2% vs 13.8%; P<.0001>
  • Adjusted incidence rate per 1000 person-years (PY) was likewise lower (20.8 [95% CI, 19.2-21.5] vs 30.4 [95% CI, 29.2-31.7]; P<.0001>
  • DAA regimens (HR, 0.57) and PR (HR, 0.78) reduced CVD risk vs controls (both P<.0001>
  • Adjusted incidence rate (per 1000 PY) for CVD events was lower with DAAs (16.3; 95% CI, 14.7-18.0) than PR (23.5; 95% CI, 21.8-25.3).
    • Both had greater effect (P<.0001 vs controls ci>
  • Among treated patients, attainment of sustained virologic response at >12 weeks posttherapy yielded 13% lower odds of CVD event (HR, 0.87; P=.03).
  • Findings were supported in subanalysis by event type (stroke, cardiac event).

Limitations

  • Reliance on ICD-9/10 codes, retrospective design.

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