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Hepatitis C treatment reduces stroke and heart attack risk

Keith Alcorn
18 February 2021
Image: Mungkhood Studio/

Hepatitis C treatment reduces the risk of subsequent stroke or heart attack by between 25 and 35%, a meta-analysis of studies published in the Journal of Viral Hepatitis shows.

People with hepatitis C have a higher risk of cardiovascular disease. A meta-analysis of 22 studies, published in 2016, found that hepatitis C raised the risk of cardiovascular events by 30% and the risk of stroke by 35%.

However, it has been unclear if curing hepatitis C reduces that risk, or if people cured of hepatitis C remain at higher risk of heart attack and stroke due to long-term damage caused by hepatitis C infection. Several studies have failed to find any effect of treatment on cardiovascular risk and it is unclear how treating and curing hepatitis C might lead to improved outcomes.

Chinese researchers at the Beijing Anzhen Hospital at Capital Medical University carried out a systematic review of studies which looked at the risk of cardiovascular events in people with hepatitis C, treated and untreated.

They identified eleven cohort studies carried out in Europe, North America and Taiwan. Seven of the eleven studies reported on outcomes in cohorts where some participants received interferon-based treatment. Four studies reported on outcomes in people treated with direct-acting antivirals. The meta-analysis compared outcomes in 309,470 people treated for hepatitis C.

Four studies compared cardiovascular outcomes in people treated for hepatitis C and those who were untreated. Any treatment was associated with a 36% reduction in the risk of cardiovascular disease (odds ratio 0.64, 95% CI 0.50-0.83).

Any treatment for hepatitis C reduced the risk of coronary artery disease by 27% (OR 0.73, (5% CI 0.55-0.96), meta-analysis of five studies showed.

Five studies looked at the risk of stroke. Any treatment reduced the risk of stroke by 26% (OR 0.74, 95% CI 0.64-0.86).

Five studies compared cardiovascular outcomes in people cured of hepatitis C and people who were not cured. Curing hepatitis C reduced the risk of any cardiovascular outcome by 26% (HR 0.74. 95% CI 0.60-0.72).

The investigators point to several routes by which curing hepatitis C might limit cardiovascular disease. Hepatitis C is known to cause endothelial dysfunction, in which the walls of blood vessels lose elasticity, raising blood pressure and constricting blood supply to the heart. Direct-acting antivirals improve endothelial function.

Direct-acting antiviral therapy also improves diabetes and pre-diabetes, and several studies have shown that the impact of direct-acting antivirals on cardiovascular disease is more pronounced in people with type 2 diabetes.