Hepatology (Baltimore, Md.) 2017 05 24() doi 10.1002/hep.29285
Liver fibrosis is common, particularly in human immunodeficiency virus infected (HIV+) people. HIV+ people have excess congestive heart failure (CHF) risk compared to uninfected people. It remains unknown if stage of liver fibrosis influences the CHF risk or if HIV or hepatitis C virus (HCV) infection modifies this association. Our objectives were to assess whether: 1) stage of liver fibrosis is independently associated with incident CHF; 2) the association between stage of liver fibrosis and incident CHF is modified by HIV/HCV status. Participants alive on or after 4/1/2003 in the Veterans Aging Cohort Study were included. Those without prevalent cardiovascular disease (CVD) were followed until their first CHF event, death, last follow-up date or 12/31/2011. Liver fibrosis was measured by FIB-4, calculated using age, aminotransferases and platelets.
incident CHF (ICD-9 codes). Cox proportional hazards regression models were adjusted for CVD risk factors. Among 96,373 participants over 6.9 years, 3,844 incident CHF events occurred. FIB-4 between 1.45-3.25 (moderate fibrosis) and FIB-4>3.25 (advanced fibrosis/cirrhosis) were associated with CHF (HR (95% CI)=1.17 (1.07-1.27); 1.65(1.43-1.92)). The association of advanced fibrosis/cirrhosis and incident CHF persisted regardless of HIV/HCV status.
Moderate and advanced liver fibrosis/cirrhosis are associated with an increased risk of CHF. The association for advanced fibrosis/cirrhosis persists even among participants without hepatitis C and/or HIV infection. Assessing liver health may be important for reducing the risk of future CHF events, particularly among HIV and hepatitis C infected people among whom CVD risk is elevated and liver disease is common. This article is protected by copyright. All rights reserved.