Risk of acute myocardial infarction (AMI) in hepatitis C positive and negative men


In a propensity score matched (PSM) cohort and a low cardiovascular disease risk cohort the incidence of AMI was compared between hepatitis C positive and negative men according to national cholesterol program guidelines lipid strata. The study population was taken from the Veterans Administration HCV cohort (ERCHIVES). In the PSM cohort 85,863 men were identified and in the low cardiovascular disease cohort 55,814 HCV positive and 84,772 negative men were included. The incidence of myocardial infarction was higher among HCV-positive men in higher strata of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL) in both cohorts. In contrast to the high lipid strata the risk for AMI in the low lipid strata was higher in the HCV-negative men. The incremental risk increase with higher lipids was greater in the HCV-positive men.

Butt et al. Clin Infect Dis 2017;65:557-565

Comment: The relationship between hepatitis C and risk of developing AMI is obviously quite complex. The fact that HCV by itself may lower the levels of TC and LDL does not make the relationship less complex. Perhaps the practical conclusion of these results should be a more aggressive approach to cardiovascular prevention strategies in HCV infected individuals.