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Abstract Details
Impact of direct acting antivirals (DAAs) on cardiovascular events in HCV cohort with pre-diabetes
Nutr Metab Cardiovasc Dis. 2021 May 1;S0939-4753(21)00186-1.doi: 10.1016/j.numecd.2021.04.016. Online ahead of print.
Ferdinando Carlo Sasso1, Pia Clara Pafundi2, Alfredo Caturano2, Raffaele Galiero2, Erica Vetrano2, Riccardo Nevola2, Salvatore Petta3, Anna Ludovica Fracanzani4, Carmine Coppola5, Vito Di Marco3, Antonio Solano6, Rosa Lombardi4, Mauro Giordano2, Antonio Craxi3, Alessandro Perrella7, Celestino Sardu2, Raffaele Marfella2, Teresa Salvatore8, Luigi Elio Adinolfi2, Luca Rinaldi9
Author information
1Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138, Naples, Italy. Electronic address: ferdinando.sasso@unicampania.it.
2Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138, Naples, Italy.
3Division of Gastroenterology and Hepatology, PROMISE, University of Palermo, Palermo, Italy.
4Department of Pathophysiology and Transplantation, Fondazione Ca' Granda IRCCS Ospedale Maggiore Policlinico, University of Milan, Italy.
5Unit of Internal Medicine and Hepatolology, Gragnano Hospital, ASL Napoli 3 Sud, Gragnano, Napoli, Italy.
6Unit of Hepatology, Pellegrini Hospital, ASL Napoli 1 Centro, Naples, Italy.
7Infectious Diseases at Health Direction, AORN A. Cardarelli, Naples, Italy.
8Department of Precision Medicine, University of Campania Luigi Vanvitelli, Via De Crecchio 7, 80138, Naples, Italy.
9Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Piazza Luigi Miraglia 2, 80138, Naples, Italy. Electronic address: luca.rinaldi@unicampania.it.
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.