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Published on: November 7, 2018
Hepatitis B Virus Infection and the Risk of Cardiovascular Disease: Findings From the China Kadoorie Biobank
Chun-Rui Wang1, Qian Zhu2, Feng-Chuan Jing3
1Department of Infectious Diseases, Institute for Viral Hepatitis, the Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Hepatitis B virus (HBV) infection is linked to a lower risk of ischemic heart disease but a higher risk of intracerebral hemorrhage in Chinese adults. Further research is needed to understand the mechanisms behind these cardiovascular disease associations.
Area of Science:
- Epidemiology
- Cardiovascular Medicine
- Infectious Diseases
Background:
- Evidence linking Hepatitis B virus (HBV) infection and cardiovascular disease (CVD) risk is limited and inconsistent.
- No comprehensive epidemiological studies have investigated this association in China.
Purpose of the Study:
- To conduct a nationwide prospective cohort study in China to investigate the association between HBV infection and CVD risk.
- To analyze the impact of HBV on various cardiovascular outcomes including ischemic heart disease, ischemic stroke, intracerebral hemorrhage, acute myocardial infarction, and heart failure.
Main Methods:
- A nationwide prospective cohort study involving 477,126 adults without prior CVD history, recruited from 10 diverse Chinese regions (2004-2008) and followed until December 31, 2016.
- Cox regression analysis was used to calculate adjusted hazard ratios (HR) for CVD incidence.
- Subgroup analyses and sensitivity analyses were performed to identify potential effect modifiers and confirm findings.
Main Results:
- During a mean follow-up of 9.94 years, significant associations were observed for specific CVD outcomes.
- Hepatitis B surface antigen (HBsAg)-positive participants showed a decreased risk of ischemic heart disease (HR: 0.91, 95% CI: 0.84, 0.98) but an increased risk of intracerebral hemorrhage (HR: 1.25, 95% CI: 1.07, 1.46).
- No significant associations were found for ischemic stroke, acute myocardial infarction, or heart failure. These findings were consistent across various demographic and lifestyle subgroups.
Conclusions:
- Hepatitis B virus infection is associated with a reduced risk of ischemic heart disease but an elevated risk of intracerebral hemorrhage in the Chinese population.
- The observed associations were robust and not modified by common demographic or lifestyle factors.
- Further research is warranted to elucidate the underlying biological mechanisms connecting HBV infection to these distinct cardiovascular outcomes.
Abstract:
The existing evidence on the association of hepatitis B virus (HBV) infection with the risk of cardiovascular disease (CVD) is limited and mixed. Moreover, no epidemiological studies have been conducted to comprehensively investigate this association in China. Hence, we performed a nationwide prospective cohort study to address these issues. Our study included 477,126 adults without a history of CVD. Participants were recruited from 10 diverse areas in China during 2004-2008, and followed up through December 31, 2016. Adjusted hazard ratio (HR) for CVD incidence was calculated using Cox regression. Subgroup analyses were conducted to identify the potential effect modifiers. During a mean follow-up of 9.94 years, 32,841 ischemic heart disease events, 35,532 ischemic strokes, 5538 intracerebral haemorrhages, 3165 acute myocardial infarction events, and 2939 heart failure events were observed. HBsAg-positive participants had a lower risk of ischemic heart disease [HR: 0.91, 95% confidence interval (CI): 0.84, 0.98; p: 0.011] but a higher risk of intracerebral haemorrhage (HR: 1.25, 95% CI: 1.07, 1.46; p: 0.004) than HBsAg-negative participants. These associations could not be modified by age, sex, study area, body mass index, regular alcohol intake, regular smoking, and physical activity level, and remained in a series of sensitivity analyses. No significant associations were found for ischemic stroke, acute myocardial infarction, and heart failure in the whole study population. In conclusion, HBV infection confers a decreased risk of ischemic heart disease but an increased risk of intracerebral haemorrhage in this Chinese population. More studies are needed to clarify the corresponding mechanisms.
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