title: The risk of coronary artery disease and cerebrovascular disease in patients with hepatitis C: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Some studies suggest that patients with hepatitis C virus (HCV) infection have an increased risk of coronary artery disease (CAD) and cerebrovascular disease. Unfortunately, available data on this association are widely variable. We have performed a systematic review and meta-analysis of literature to evaluate the risk of cardio-cerebrovascular disease (CCD) associated with HCV.
  
  
  METHODS
  Studies reporting on CCD risk associated with HCV were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases.
  
  
  RESULTS
  Twenty-seven studies (34 data-sets) showed a significantly increased CCD risk in 297,613 HCV patients as compared with 557,814 uninfected controls (OR: 1.428; 95% CI: 1.214, 1.681). These results were confirmed when separately considering the risk of CAD (20 studies, OR: 1.382; 95% CI: 1.103, 1.732) and of cerebrovascular disease (13 studies, OR: 1.485; 95% CI: 1.079, 2.044). Similar results were confirmed when analyzing 21 studies reporting adjusted risk estimates (OR: 1.448; 95% CI: 1.218, 1.722) and when, after excluding studies defining CAD as positive angiographic or electrocardiographic evidence, we specifically included the 17 studies reporting on acute CCD-related events (OR: 1.357; 95% CI: 1.103, 1.670). Moreover, 4 studies evaluating CCD-related deaths showed a higher risk in HCV patients than controls (OR: 1.772; 95% CI: 1.448, 2.168; P<0.0001). Meta-regression models suggested a direct association between prevalence of cirrhosis and difference in CCD risk between HCV patients and controls.
  
  
  CONCLUSIONS
  Results of our large meta-analysis suggest that HCV-infected subjects experience an increased risk of CCD. This should be considered to plan specific cardiovascular prevention strategies in this clinical setting.
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ambrosino
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lupoli
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Minno
authors.affiliation: Department of Surgery, Interventional Hepatology, Andrea Tortora Hospital, Pagani, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Tarantino
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Spadarella
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Tarantino
authors.affiliation: Department of Surgery, Unit of General Surgery and Oncology, Andrea Tortora Hospital, Pagani, Italy.
authors.forename: Aurelio
authors.initials: A
authors.lastname: Nasto
authors.affiliation: Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Celentano
authors.affiliation: Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy. Electronic address: dario.diminno@hotmail.it.
authors.forename: Matteo Nicola Dario
authors.initials: MN
authors.lastname: Di Minno
mesh_terms: D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Coronary artery disease; Hepatitis C; Myocardial infarction; Stroke