title: Performance of the Pooled Cohort atherosclerotic cardiovascular disease risk score in hepatitis C virus-infected persons.
abstract: Chronic hepatitis C virus (HCV) infection has been associated with an increased risk for cardiovascular disease (CVD). The recommended Pooled Cohort atherosclerotic cardiovascular disease (ASCVD) risk equation for estimation of 10-year CVD risk has not been validated in HCV-infected populations. We examined the performance of the ASCVD risk score in HCV-infected persons, using the national Electronically Retrieved Cohort of HCV Infected Veterans to derive a cohort of HCV-infected and uninfected subjects without baseline ASCVD, hepatitis B, or HIV infection, and with low-density lipoprotein cholesterol level<190 mg/dL. Performance of the ASCVD risk equation was assessed by Cox proportional hazard regression, C-statistics and Hosmer-Lemeshow statistic. The cohort included 70 490 HCV-infected and 97 766 HCV-uninfected men with mean age of 55 years, 56% White and 29% Black. Incident CVD event rates were similar between the two groups (13.2 and 13.4 events/1000 person-years), with a higher incidence of coronary heart disease events in the HCV-uninfected group and of stroke events in the HCV-infected group. Adjusting for ASCVD risk score, HCV infection was associated with higher risk for an ASCVD event in the subgroup with baseline ASCVD risk ≥7.5% (HR: 1.19, P<.0001). C-statistics were poor in both the HCV-infected and uninfected groups (0.60 and 0.61, respectively). By Hosmer-Lemeshow test, the ASCVD risk equation overestimated risk amongst lower risk patients and underestimated risk amongst higher risk patients in both the HCV-infected and uninfected groups. Further investigation is needed to determine whether a modified equation to accurately predict ASCVD risk in HCV-infected persons is warranted.
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: K W
authors.identifier: 0000-0003-4865-4348
authors.initials: KW
authors.lastname: Chew
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Bhattacharya
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: T B
authors.initials: TB
authors.lastname: Horwich
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: P
authors.initials: P
authors.lastname: Yan
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
authors.forename: K A
authors.initials: KA
authors.lastname: McGinnis
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Tseng
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.|VA Tennessee Valley Healthcare System, Nashville, TN, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Freiberg
authors.affiliation: Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Currier
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.|Weill Cornell Medical College, Doha, Qatar.|Weill Cornell Medical College, New York, NY, USA.|Hamad Medical Corporation, Doha, Qatar.|Hamad Healthcare Quality Institute, Doha, Qatar.
authors.forename: A A
authors.initials: AA
authors.lastname: Butt
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology* / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D005260:Female; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications* / Q000821:virology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: atherosclerotic cardiovascular disease score; cardiovascular disease; cardiovascular risk assessment; hepatitis C virus