Hepatitis C and risk of coronary atherosclerosis – A systematic review

• The summation of observational studies on the association between hepatitis C and coronary atherosclerosis has been a challenge.
• By careful outcome classification and further data syntheses, we have elucidated important aspects of the association.
• Observational studies of coronary atherosclerotic lesions via coronary angiography show that hepatitis C virus or factors associated with HCV infection are associated with increased risk of occurrence of coronary atherosclerosis and increased severity of coronary atherosclerosis.
• While the overall risk estimate for coronary atherosclerosis-related events points to a null association, sub analyses show contrasting results.
• The sum of cohort studies on risk of coronary atherosclerosis-related events with hepatitis C suggest positive risk.
• The sum of case-control studies on the same association suggest decreased risk.

BackgroundObservational studies on the association of chronic hepatitis C with coronary atherosclerosis have shown varying results and previous related reviews have been inconclusive. By careful outcome classification and further data syntheses, we aimed to clarify current evidence on the association between hepatitis C infection and coronary atherosclerosis.MethodsThrough systematic searches of PubMed and Scopus, related published observational studies were identified. These were narrowed by review of abstract, full review and quality assessment to yield eligible studies. These were used in qualitative and quantitative syntheses.ResultsThe initial search identified 274 unique publications, which were narrowed to 15 by means of preliminary reviews, and narrowed further to 10 by quality assessment. The endpoints assessed varied, representing different attributes of the disease. The 10 studies were used in the subsequent meta-analyses. The risk of a person with chronic hepatitis C developing coronary atherosclerosis is about triple the risk in uninfected persons (OR = 3.06, 95% CI = 1.99–4.72). Coronary atherosclerosis in persons with chronic hepatitis C is also more severe. The pooled risk of coronary atherosclerosis-related events in persons with chronic hepatitis C was null (OR = 1.10 95% CI = 0.80–1.52).ConclusionThe current evidence indicates that hepatitis C virus or factors associated with HCV infection are apparently associated with increased risk of occurrence of coronary atherosclerosis and probably, increased severity of coronary atherosclerosis. Evidence of association with coronary atherosclerosis-related events is yet indeterminate.