From the Journals

Metabolic syndrome predicts cardiovascular events in HBV infection


Metabolic syndrome was associated with a fourfold rise in cardiovascular events among patients with chronic hepatitis B virus infection, according to a prospective cohort study published in Hepatology.

Over a median of 7.3 years of follow-up, 8% of patients with metabolic syndrome developed ischemic or hemorrhagic stroke, acute coronary syndrome, or congestive heart failure, or underwent revascularization, compared with 2% of patients without metabolic syndrome (P less than .0001), reported Jenny Yeuk-Ki Cheng, MD, and her associates at The Chinese University of Hong Kong.

But it was liver stiffness measure (LSM), not metabolic syndrome, that predicted hepatic events (hazard ratio, 1.6; 95% confidence interval, 1.0 to 2.5) and death (HR, 1.9; 95% CI, 1.1 to 3.2), the investigators reported (Hepatology. 2016 Sep 29. doi: 10.1002/hep.28778).

Their study included 1,466 patients with chronic HBV infection who averaged 46 years of age, with an average baseline LSM of 8.4 kPa (standard deviation, 6.3 kPa). A total of 188 patients (12.8%) had metabolic syndrome at baseline, defined as at least three of the following five factors: central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol, hypertension, and type 2 diabetes mellitus or fasting hyperglycemia.

Hepatitis B virus ©sarathsasidharan/Thinkstock

In all, 44 patients (3.0%) developed cardiovascular events during follow-up, while 93 (6.3%) developed cirrhotic events and hepatocellular carcinoma, and 70 (4.8%) died. Patients whose LSM exceeded 8.0 kPa at baseline had a significantly higher cumulative risk of hepatic events over the next 8 years than did patients with lower baseline LSM (12.3% versus 3%; P less than .001).

But high LSM “had no impact on cardiovascular events,” just as metabolic syndrome did not increase the risk of hepatic events or death, the investigators said. The study, the first to evaluate this group of clinical correlates in HBV-infected patients, highlights the need to monitor their metabolic risk factors over time, they concluded.

The researchers reported having no funding sources. Dr. Cheng had no relevant financial disclosures, although other coauthors reported multiple relationships with pharmaceutical and device firms.

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