Screening for metabolic syndrome warranted in chronic hepatitis B
medwireNews: Metabolic syndrome increases the risk for cardiovascular events in patients with chronic hepatitis B virus (HBV) infection, study findings indicate.
This suggests that “hepatology specialists and general practitioners should regularly monitor metabolic risk factors in addition to liver disease in all [chronic HBV] patients,” say Grace Lai-Hung Wong and colleagues from The Chinese University of Hong Kong.
Wong and team prospectively followed up 1466 patients (mean age 46 years) with chronic HBV infection for an average of 88 months. At baseline, 188 (12.8%) patients had metabolic syndrome and the mean liver stiffness measurement (LSM) was 8.4 kPa.
During follow-up, 44 patients developed cardiovascular events that included acute coronary syndrome and cerebrovascular events. And the cumulative probability of such events was significantly higher among patients with metabolic syndrome, compared with those without it, at 8.0% versus 2.2% (p<0.001).
Furthermore, metabolic syndrome was independently associated with a significant 2.2-fold increased risk for cardiovascular events on multivariate analysis (p=0.004), but was not associated with the risk for hepatic events.
There were 93 patients who developed hepatic events during follow-up, defined as any cirrhotic complications, hepatocellular carcinoma and/or liver-related mortality, with the 8-year cumulative probability significantly higher for those with a high (>8.0 kPa) versus lower (≤8.0kPa) baseline LSM, at 12.3% and 3.1% (p<0.001), respectively.
On univariate analysis, high LSM was associated with a fourfold increased risk for hepatic events (p<0.001), but this decreased to 1.6-fold, with marginal statistical significance (p=0.054), upon multivariate adjustment for factors including antiviral treatment.
Wong et al suggest that this shows “antiviral treatment has modified the natural history of these [chronic HBV] patients, decreasing the impact of high baseline LSM on long-term outcome.”
Of note, high LSM had no impact on cardiovascular events.
The researchers analysed data for the 70 deaths that occurred during follow-up. They found that high baseline LSM, but not metabolic syndrome, was independently associated with mortality, at an adjusted hazard ratio of 1.9 (p=0.023).
Writing in Hepatology, Wong and co-researchers conclude: “[A]lthough metabolic syndrome does not increase the risk of hepatic events in [chronic HBV] patients, it poses a threat of cardiovascular events and death.”
They add: “[Chronic HBV] patients suffering from metabolic syndrome at the same time should have their metabolic risk factors under control and closely monitored for cardiovascular events. Future studies are needed to demonstrate the impact of managing metabolic syndrome in the long term.”
By Laura Cowen
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