1. Impact of direct acting antivirals (DAAs) on cardiovascular events in HCV cohort with pre-diabetes
- Author
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Riccardo Nevola, Rosa Lombardi, Celestino Sardu, Antonio Solano, Antonio Craxì, Anna Ludovica Fracanzani, Pia Clara Pafundi, Teresa Salvatore, Raffaele Marfella, Ferdinando Carlo Sasso, Alessandro Perrella, Mauro Giordano, Erica Vetrano, Alfredo Caturano, Luigi Elio Adinolfi, Luca Rinaldi, Carmine Coppola, Salvatore Petta, Raffaele Galiero, Vito Di Marco, Sasso F.C., Pafundi P.C., Caturano A., Galiero R., Vetrano E., Nevola R., Petta S., Fracanzani A.L., Coppola C., Di Marco V., Solano A., Lombardi R., Giordano M., Craxi A., Perrella A., Sardu C., Marfella R., Salvatore T., Adinolfi L.E., Rinaldi L., Sasso, F. C., Pafundi, P. C., Caturano, A., Galiero, R., Vetrano, E., Nevola, R., Petta, S., Fracanzani, A. L., Coppola, C., Di Marco, V., Solano, A., Lombardi, R., Giordano, M., Craxi, A., Perrella, A., Sardu, C., Marfella, R., Salvatore, T., Adinolfi, L. E., and Rinaldi, L.
- Subjects
Male ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Cardiovascular risk, Direct acting antivirals,Hepatitis C virus,Prediabetes, Aged, Antiviral Agents, Cardiovascular Diseases, Female,Heart Disease Risk Factors, Hepatitis C, Humans, Incidence, Italy, Longitudinal Studies, Male, Middle Aged, Prediabetic State, Prospective Studies, Protective Factors, Retrospective Studies, Risk Assessment,Time Factors, Treatment Outcome, Viral Load ,Medicine (miscellaneous) ,Type 2 diabetes ,030204 cardiovascular system & hematology ,medicine.disease_cause ,DIRECT ACTING ANTIVIRALS ,Liver disease ,0302 clinical medicine ,Longitudinal Studies ,Prospective Studies ,Prediabetes ,education.field_of_study ,Nutrition and Dietetics ,Incidence ,Middle Aged ,Viral Load ,Hepatitis C ,Treatment Outcome ,Italy ,Cardiovascular Diseases ,Cohort ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Hepatitis C virus ,Population ,030209 endocrinology & metabolism ,Antiviral Agents ,Risk Assessment ,Prediabetic State ,03 medical and health sciences ,Internal medicine ,medicine ,Humans ,education ,Aged ,Retrospective Studies ,business.industry ,Protective Factors ,Cardiovascular risk ,medicine.disease ,Heart Disease Risk Factors ,Direct acting antiviral ,Hepatitis C viru ,business ,Mace - Abstract
Background and aims: Beyond type 2 diabetes, even a condition of prediabetes is associated with an increased cardiovascular (CV) risk, and HCV infection coexistence represents an exacerbating factor. CV prognosis improvement in prediabetes represents a challenge, due to the increasing prevalence of this metabolic condition worldwide. Hence, we aimed to prospectively assess how direct acting antivirals (DAAs) could affect major cardiovascular events (MACE) in a prediabetic HCV positive cohort. Methods and results: In this prospective multicenter study, we enrolled HCV patients with overt prediabetes. We compared a subgroup of patients treated with DAAs with untreated prediabetic controls. We recorded all CV events occurred during an overall median follow-up of 24 months (IQR 19–34). 770 HCV positive prediabetic patients were enrolled, 398 untreated controls and 372 DAAs treated patients. Overall, the CV events annual incidence was much higher among prediabetic treated patients (1.77 vs. 0.62, p < 0.001), and HCV clearance demonstrated to significantly reduce CV events (RR: 0.411, 95%CI 0.148–1.143; p < 0.001), with an estimated NNT for one additional patient to benefit of 52.1. Moreover, an independent association between a lower rate of CV events and HCV clearance after DAAs was observed (OR 4.67; 95%CI 0.44–53.95; p = 0.016). Conclusions: HCV eradication by DAAs allows a significant reduction of MACEs in the prediabetic population, and therefore represents a primary objective, regardless of the severity of liver disease and CV risk factors.
- Published
- 2021