HCV linked to 43% increased risk for cardio-cerebrovascular disease

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  • Hepatitis C virus (HCV)-infected patients carry a 43% increased risk for cardio-cerebrovascular disease (CCD), driven at least in part by the presence of cirrhosis.

Study design

  • Systematic review and meta-analysis of 27 studies (34 data-sets) involving 297,613 HCV-infected patients and 557,814 control patients.
  • Meta-regression analyses adjusted for demographic variables, antiviral therapy, concomitant medications, and traditional cardiovascular risk factors.

Key results

  • HCV was linked to a significantly increased risk for CCD vs control patients (OR, 1.428; 95% CI, 1.214-1.681; P<.0001).
  • Subgroup analysis confirmed the association between HCV and coronary artery disease (CAD; 20 studies: OR, 1.382; 95% CI, 1.103-1.732; P=.005), and cerebrovascular disease (13 studies: OR, 1.485; 95% CI, 1.079-2.044; P=.015).
  • CCD findings were confirmed by a sensitivity analysis of 21 studies reporting adjusted risk estimates (OR, 1.448; 95% CI, 1.218-1.722; P<.0001).
  • After excluding studies defining CAD as positive angiographic or electrocardiographic evidence, 17 remaining studies of acute CCD-related events also supported the association (OR, 1.357; 95% CI, 1.103-1.670; P=.004).
  • 4 studies evaluating CCD-related deaths also showed an increased risk for HCV-infected patients vs control patients (OR, 1.772; 95% CI, 1.448-2.168; P<.0001).
  • Meta-regression models suggested a direct association between cirrhosis prevalence and increased HCV-related CCD risk (OR, 1.498; 95% CI, 1.246-1.802; P<.0001).


  • Significant heterogeneity between studies, including variations in criteria used to define CCD.

Why this matters 

  • Studies of the association between HCV and CCD have yielded highly variable results.
  • Cardiovascular prevention strategies should be considered for patients with HCV.